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Consumer Complaint Form

Please use this form to send us a patient complaint. Complaints provide an opportunity to continually assess and improve our service.

  1. Your complaint will be acknowledged to you within five working days of receipt.
  2. We will endeavour to investigate your complaint within 20 working days from the date of acknowledgement. You will be informed if this will take longer and the reasons this is neccessary.
  3. Where extensive investigations are required, you will be kept informed in writing at monthly or at agreed intervals until the matter is resolved.

If you require independent support to assist you during the complaint process, you may wish to use the free service of:

Health and Disability Advocacy Service and Maori Advocacy Service
Telephone +64 3 337 7501
Unit 1, Amuri Park
Corner of Churchill Street & Bealey Avenue
PO Box 1307, Christchurch

Health and Disability Commissioner's Office (http://www.hdc.org.nz)
Telephone 0800 11 22 33
PO Box 12299, Wellington

Complaint Details (fields marked with * are required)
Your Full Name: *
Your Street Address: 
Your Phone No: 
(incl. country code)
Your Fax No: 
(incl. country code)
Your Email Address: *
Patient Name: *
Patient Address: *
Please check this box if you 
are making the complaint
on behalf of someone else: 		 Yes, I am making complaint on behalf of someone else
Date(s) of complaint event: 
Person(s) involved: 
(if known)
Where did the event take place ?: *
Ward/Department Unit: 
Please state your concern: *