ADHD Treatment Australia - Complaints Form

We value your feedback and take all concerns seriously. Complaints about your care or any aspect of our service can be submitted using this form.

YOUR DETAILS

Complainant First Name

Complainant Last Name

Complainant Email

Complainant Phone

On behalf of

I am submitting this complaint on behalf of a patient

Complainant relationship to patient

PATIENT DETAILS

Patient First Name

Patient Last Name

Patient Email

Patient Tel

Patient consent

I have the patient's consent to make this complaint

Privacy obligations acceptance

I acknowledge that ADHD Treatment Australia may be required to verify patient consent and that, without it, privacy obligations may limit the information that can be disclosed in response to this complaint.

Privacy consent

I understand that ADHD Treatment Australia may need to review my records and contact relevant staff or clinicians to investigate this complaint. I understand that my information will be handled confidentially and only used for the purpose of reviewing and responding to my complaint.

COMPLAINT DETAILS

Complaint is about

Incident Date

Complaint description

How has this affected the patient?

Preferred Outcome

Concern raised before?

I have raised this concern with ADHD Treatment Australia before

When was the concern raised?

Previously discussed with

SUPPORTING DOCUMENTS

Upload any supporting documents here. You may select multiple files (maximum 10 files, 2MB each). Accepted formats: JPG, PNG, PDF.

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ADHD Treatment Australia - Complaints Form

This free ADHD screening test is designed for individuals who believe they might benefit from a more detailed ADHD evaluation.

SUBMIT YOUR DETAILS TO REVEAL RESULTS