Feedback and Complaint.

Kita Therapy Compliment, Complaint and Feedback Registration Form

Kita Therapy is committed to providing high-quality care and services and meeting your needs. We value your feedback – including complaints.

Please let us know what we do well and where we can improve our services.

Indicate your response below- this is a:

Compliment Complaint Feedback

Do you want to remain anonymous?

Yes No

Do you require an interpreter?

Yes No

Name of the person that the feedback concerns

Contact person’s name and position in the service

Please provide details of your main concerns, including what events led to making the complaint, compliment or feedback, approximate dates and who was involved

Have you discussed your concerns with the service provider or another agency or person for assistance with these concerns?

Yes No

If yes, with whom and what was the outcome?

What outcomes would you like as a result of providing your feedback?

Section 5: Privacy
Kita Therapy is committed to protecting your privacy. We collect and handle personal information that you provide on this feedback form for the purpose of investigating and responding.

Kita Therapy will only use your information in accordance with relevant privacy and other laws. In order for us to provide services to you effectively and efficiently, we may need to share your personal information with others that deals with the matters identified in your feedback.

If you choose to remain anonymous, Kita Therapy may be unable to deliver the full range of services you require.

G04/659 Gardeners Rd, Mascot NSW 2020

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1300 941 174

1300 941 174

Feedback and Complaint.

Kita Therapy Compliment, Complaint and Feedback Registration Form

1300 941 174

No Waitlist

For Speech Pathology Services at Kitatherapy!