Online Complaint Form

Please note: This form is to be used only if you wish to lodge your complaint electronically.

If you need help to fill in this form, please contact the HCSCC Enquiry Service:
Monday – Friday, 9.00am – 5.00pm
Toll Free to landline country callers in SA
1800 232 007

Please download our complaint form (print version) if you would like to lodge your complaint with HCSCC in a hard copy format.

Do you need an interpreter?

If yes, please let us know which language and dialect you refer

Do you need an interpreter?

Part 1

The person the complaint is about





Part 2


Details of the person who received the service

Part 3


Your details if you are making this complaint for someone else

Part 4


Details of the service that the complaint is about
Please tell us how long you have been with this service e.g. in weeks, months or years. Please enter a number next to the most appropriate time frame.

Tell us about the complaint



Part 5 Attaching additional documents


Acceptable file types: doc,docx,rtf,pdf,txt,gif,jpg,jpeg,png.
Maximum file size: 1mb.

Part 6 Completion and lodgment

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If you want to keep a copy of this form print it out now.

Other HCSCC resources can be downloaded from HCSCC Resources and publications