Online Complaint Form Please fill in the form below if you want to lodge a complaint and we will get back with you shortly – thank you. Complaint Complaint Details Name of Person Making Complaint * Name of Person Making Complaint First First Last Last Participant Name (if different from the person making the complaint) Does any participant concerned know you are making the complaint? (if applicable) Yes No – If no, we cannot proceed until they have provided their informed consent that the complaint be made. Person or Program complaint is regarding (if applicable) Nature of Complaint * Action or Change sought from Brain Injury SA to Address Complaint? (if known) Would you like a response to this Complaint? * Yes – if yes, please nominate how you would like to receive the response. No Complaint Response Type: By Telephone By Email By Postal Mail Contact Number * Email * Postal Address * If you are human, leave this field blank. Submit
