Thank you for taking the time to provide us with your feedback. At Complete Skin Specialists, we aim to deliver safe, high quality dermatology care, and your experience is important to us. If you have concerns about the service or care you received, we appreciate you letting us know so we can review the matter and continue improving our practice.

Please complete the form below with as much information as possible. Your feedback will be handled confidentially and in accordance with the Health Records Act 2001 (Vic), the Health Complaints Act 2016 (Vic) and the Australian Privacy Principles.

Personal & Contact Information

First Name

Last Name

Date of Birth

Phone Number

Email Address

Do you give permission for us to contact you to discuss your feedback? *

Yes No

Preferred Contact Method *

Patient Feedback Information

Date of Incident

Location Site

Name of the staff member or team involved

Type of Feedback

Describe your concern

What outcome would you like from this complaint?

If other:

Please upload any supporting information

Browse

Privacy:

I understand that Complete Skin Specialists will collect personal information for the purpose of reviewing and responding to my feedback. This information will be handled in accordance with the Health Records Act 2001 (Vic), the Privacy Act 1988 (Cth), and the Australian Privacy Principles.

I acknowledge that my feedback may need to be reviewed by senior staff including the Lead Receptionist, Team Leader, Practice Manager, or relevant clinical staff. Only those directly involved in resolving the matter will have access to the information provided.

Expected Timeframes:

I understand that:

My feedback will be acknowledged within 1 business day.
It may take up to 3 business days for the Team Leader to acknowledge the feedback.
Complete Skin Specialists aim to have a resolution within 7-10 business days
If the matter is complex or requires clinical input, it may take up to 14 business days, and the practice will notify me if extra time is required.
My feedback will be managed confidentially and respectfully, and I will be kept updated throughout the process.

Signed by Patient/Guardian *

Draw signature|Type signatureClear

Save and Complete Later