Tickit on Demand - headspace National Youth Mental Health Foundation

This form is used to record any compliments, complaints and/or suggestions about headspace programs and services.

If this is NOT feedback about a headspace program or service, please submit your request/comment via the contact us form:

https://headspace.org.au/contact-us/

headspace Service^*

Program Area^*

What is your name?

Phone number

Email address

Type of Feedback^*

ComplimentComplaintSuggestion

Are you a headspace staff member?^*

YesNo

If you selected "Other" please detail how you were informed^*

Outline specific details relating to how the feedback was received ^*

i.e. phone call to reception; email to info@headspace.org.au.

PLEASE REMEMBER TO ATTACH ANY DOCUMENTS OR EMAILS RELATED TO THIS COMPLAINT AT THE END OF THIS FORM

Complainant's Name

Complainant's Contact Details

Date informed of feedback.^*

Time informed of feedback^*

If feedback is a complaint, did you advise person of complaint process including response timelines^*

YesNoFeedback is not a complaint

Feedback^*

Please provide details of your feedback regarding headspace services

Tell us how you would like this resolved?

Are you completing this form on behalf of someone else?^*

YesNo

What is your relationship to the person you are completing the form on behalf of?^*

If you selected 'other' please outline your relationship

Do you consent to headspace publishing your compliment to promoteÂ headspaceÂ services and encourage help seeking behaviour?’^*

YesNo