Client, Carer and Community Feedback Form

Your voice is important - help us help you quickly.

If you are at an overnight stay service e.g. The Woolshed or any of DASSA's withdrawal service, discuss any concerns with the Manager in charge.

If you are not at an overnight stay service, discuss any concerns with the person who is providing you with care or treatment.

This helps resolves issues quickly.

You are still welcome to submit this form or contact the Consumer Advisory Service (SALHN) / Executive Services (DASSA) if you are not happy with the way your feedback has been managed or resolved.

Your personal information will be kept private and only shared with those involved in considering your feedback or resolving your complaint.

Read more about how you can help improve DASSA's services through our Community Partnership Program

Question Title

* Please indicate the type of feedback you are providing:

Compliment

Complaint

Suggestion

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* Is the client (i.e. the person who has received care or treatment) an:

Overnight stay client

Outpatient

Other (please specify)

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* Which DASSA service was attended:

The Woolshed

Alcohol & Drug Information Service (ADIS)

Aboriginal Clinical Services

Outpatient Service

Withdrawal Service

Question Title

* Please provide your contact details:

Name

Address

Suburb

State

Post Code

Country

Email Address

Phone Number

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* What would you like to tell us?

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* What would you like to see happen?

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* If you are not the client/patient. For feedback or complaints regarding services provided to another person (friend or relative), we cannot give you any information about the service they received without their consent.

You will need to complete a Patient Authority Form. Have you completed a Patient Authority Form?

Yes

Question Title

* Upload your completed Patient Authority Form:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File