My complaint / problem form

Use this to explain what is wrong and what you want. Keep a copy for yourself.

My name

Today’s date

My contact details

My NDIS number (optional)

Who or what is this about? When did it happen? What happened? How did this affect me? What do I want to happen? What have I already tried? (optional) Who is helping me? (optional) Anything else?

Signature (optional)

NDIS Commission (quality & safety): 1800 035 544 · ndiscommission.gov.au
If you or someone else is in immediate danger, call 000.