Make a Complaint

Online Complaint Form

Please note: Before you make a complaint, please read the information here carefully. If you are unsure and want advice, contact us.
This form is to be used only if you wish to lodge your complaint electronically. If we require further information, we will contact you.

Part 1: Complainant

MrMrsMsDrOther
Do you need an interpreter?
If yes, please let us know which language and dialect you prefer

I am making a complaint:

for myselffor someone else

I authorise the Commissioner to obtain information and personal records relevant to my complaint. For more information, click here. Proceed to Part 2.

Before you proceed, you must complete this form and submit it with the complaint. Please answer the questions below and then proceed to Part 2.

Has the person who received the service given you permission to make a complaint on their behalf?
YesNoThe person who received the service is deceased

Do you have a legal role for the person who received the service? (for example, parent of a child under 18, guardian)
YesNo

Do you agree that we can talk about this complaint with the person who received the service?
YesNo


If you are making a complaint for someone else, you must complete this form and attach it here before you proceed.

Acceptable file types: pdf.

Maximum file size: 10mb.

Part 2: Details of the person who received the service

MrMrsMsDrOther
Do you identify as (optional)
AboriginalTorres Strait IslanderBothOther
Country of Birth?

Part 3: Details of the service the complaint is about

Tell us about the complaint

How I would like my concerns resolved?
Information/ExplanationAccess serviceRefund/CompensationApologyAdequate serviceChange Policy/ProcedureTraining/education for the workerOther
Have you already tried to resolve your complaint directly with the service provider?
YesNo
Have you made your complaint to another person or organisation? (for example – an advocate, a lawyer, MP or other complaints organisation)
YesNo

Part 4: Attaching additional documents

Acceptable file types: doc,docx,rtf,pdf,txt,gif,jpg,jpeg,xlsx,xls,png.

Maximum file size: 1mb.

Part 5: Completion and lodgment

Please read our disclaimer.

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.

Complaint Form (Print Version)

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