COFFS KIDS IN MOTION
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Contact (for Parents / Carers)
Online Referral Form
Referral for NDIS Clients
Feedback Form
Please provide us with some feedback about your experience:
We encourage and welcome all feedback regarding the services provided by Coffs Kids in Motion. Providing feedback will not impact the provision of service in any way.
If the participant
or carers
wish to give feedback
or make a
complain
t regarding the provision of supports
, the
y
are encouraged to complete this form or to
speak
with
Kay Joseph
on
6652 1252
or
email
[email protected]
.
If the participant/carer does not feel comfortable
to
contact Kay Joseph
or is not satisfied with the result of the
complain
t,
the participant can contact the
NDIS Commission by
calling 1800
035 544
, or visiting
w
ww.ndiscommission.gov.au
for further information.
If the participant, or carers, are concerned regarding the physiotherapy provided, they may also contact the Australian Physiotherapy Association (
www.australian.physio
) or the Australian Health Practitioner Regulation Agency (
www.ahpra.com.au
)
What did you like about your experience?
*
What did you dislike about your experience?
*
Do you have a comment about a particular incident?
*
Your services will not be affected should you need to make a complaint
Does this incident involve a particular staff member?
*
Contact Information:
This section is not compulsory, should you wish to remain anonymous please skip this section.
Would you like to be contacted regarding this feedback?
*
Yes
No
Client's Name
*
First
Last
Parent / Carers Name
*
First
Last
Phone Number
*
Email
*
Submit
Home
Services
About
Funding sources
Contact
Contact (for Parents / Carers)
Online Referral Form
Referral for NDIS Clients
Feedback Form
