Complaint Form

Use the form below to make a complaint about an HCANZA member.

The Executive Officer will contact you within 5 working days to acknowledge receipt of your complaint.

1. Privacy

Please note that we cannot proceed with your complaint unless you are willing to disclose the nature of the complaint, your own contact details, the details of the HCANZA member about whom you are complaining to the Executive Officer of HCANZA and the Board Chair of HCANZA. They will determine if the complaint is to be investigated. They may contact you for further information and if the complaint proceeds, they will share your name with the HCANZA member who is accused by you. The details will not be shared with any other parties and if the complaint is against the Chair or the Executive Officer themselves, they will forward the complaint to the Deputy Chair of the Board of HCANZA (or the Treasurer).

Do you agree to the details on this form being seen by the Executive Officer and the Board Chair?

Yes No

Do you agree that the details of your complaint and your name (if it is to be investigated) will be seen by the accused HCANZA member?

Yes No

2. Details of the person making a complaint

Please provide your details here.

First Name

Last Name

Address

Street Address

City

State (if Australia)

Country

Phone

Interpreter required?

Yes No

3. Details of the person you have a complaint about (provide as much detail as you know)

Please provide your details here.

First Name

Last Name

Address

Street Address

City

State (if Australia)

Country

Phone

4. Details of the complaint

5. Date/Dates of Complaint (when did the event or events occur?)

6. Please complete only ONE of the following Declarations:

I am the person who has a complaint and I wish to lodge this complaint I am the parent or legal guardian representing a child (or vulnerable adult) where the child (or vulnerable adult) has received a therapeutic service from an HCANZA Member and I complain on their behalf

2022 Conference: Breaking Through 2-3 June 2022

Use the form below to make a complaint about an HCANZA member.

1. Privacy

2. Details of the person making a complaint

Address

3. Details of the person you have a complaint about (provide as much detail as you know)

Address