Patient complaint and compliment form

You can submit your feedback using this online form. Read about other options and the complaints process on the patient complaints and compliments page, or contact the complaints coordinator on (08) 8999 2579 or

If your complaint relates to a breach of information or privacy, please use our Privacy Complaint Online Form instead.

Required fields are marked with an asterisk (*).

Please note we are required to confirm consent directly with the patient and contact will be made once the feedback is received.

Submitter details

Patient details

If you are providing the feedback on behalf of someone else, provide the patient’s details below:

Feedback information

Please select the service you are providing feedback about.

The region where you accessed the service:

Last updated: 03 March 2022

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