You can talk to us about any concern or complaint about a public mental health service in Victoria.

This form has been designed as an easy way for you to provide us with initial information about your concern or complaint. We may need more information (e.g. consent) to formally accept your complaint, and we can speak with you about this.

You can also use this form to make a request for us to contact you, without completing the details of your concern or complaint. You can do this by completing the short form (link below).

Alternatively, you can download and complete this form and send it to us. You can also contact us directly.

>> Switch to short form

In this form:

Section 1  |  Section 2  |  Section 3  | Section 4  |  Section 5  |  Section 6

Section 1 - Your details

Please complete as much information as possible to enable us to contact you about this complaint.

Date of birth - If you are the person who received the service
Do you need an interpreter

Do you need assistance to communicate or to make this complaint?

Section 2 - Details of the person who received the service
Who received the service

Date of birth (if known)
Does this person need an interpreter?

Section 3 - Details of the public mental health service
Section 4 - Description of concerns

Please attach any additional documents or information below.

Section 5 - More about you

This section is optional. By providing this information, you will help us to improve our services for you and for others.

Do you identify as Aboriginal and/or Torres Strait Islander?

In which country were you born?

Do you speak a language other than English at home?

Do you identify as a person with disability?

Section 6 - Privacy

We collect and use personal and health information provided to us to respond to concerns raised. Our privacy policy explains how we use information given to us, when we can share it, and how you can request a copy of this information. Please contact us if you would like us to send you a copy of our privacy policy.