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 consumer engagement, complaints and feedback team on (08) 8999 2579 or feedback.health@nt.gov.au

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 (*).

Type of feedbackPlease SelectComplaintComplimentEnquirySuggestionComment

Who is providing the feedbackPatientFamily memberCarerOther

Patient details

MrMrsMsMissDrProfMasterSelf specified

Patient - First name

Patient - Last name

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

If you are providing feedback on someone else’s behalf, have you received consent to do so?YesNoNA

Please advise if you wish to receive a response *

• I would like to give my details as I choose to get a response/follow up
• I do not want to give my details so I will not be contacted

Feedback information

Please select the service you are providing feedback about.

The region where you accessed the service:

• Top End
• Central Australia
• Big Rivers Region (Katherine)
• East Arnhem (Gove)
• Barkly (Tennant Creek)

In case of a hospital service:Please selectAlice Springs HospitalGove District HospitalKatherine HospitalPalmerston Regional HospitalRoyal Darwin HospitalTennant Creek Hospital

In case of non-hospital services:Please selectAged careAlcohol and other drugsCancer screeningChildren's developmentClinic 34COVID-19 testingCommunity health clinicEnvironmental healthHearingImmunsationMental healthOral healthPrison health and police watch houseTerritory Equipment Program and Seating Equipment and Technical Service (TEP and SEAT)Territory PathologyTuberculosis or leprosy clinicOther

What date (approximately) did you access the service?

Provide a brief summary of your feedback (up to 5000 words) *