Complain about care you received

Successful submission

Thank you for submitting your complaint.

This complaint form gathers the information we need to review your complaint.

BEFORE YOU COMPLETE THIS COMPLAINT FORM
Before filling in the form, you may wish to talk to the person or organisation you’re unhappy with. An advocate can help you to try to resolve your complaint directly with the healthcare provider, instead of making a complaint to HDC.

When you make a complaint to HDC, we will assess your complaint and guide you to resolve it. Please know that if you make a complaint, we will discuss it with the person or organisation you are complaining about.

If you have any questions about this form, contact us at:

Email: hdc@hdc.org.nz
Phone: 0800 11 22 33
Mail: PO Box 1791, Auckland 1140, New Zealand

THE INFORMATION WE COLLECT FROM YOU
We collect personal information from you, including your contact information, health information, and demographic details such as your age group and ethnicity. We may also collect information from other people and organisations about your complaint, including related clinical records.

We collect this information to:
• help HDC to assess and resolve your complaint;
• promote and protect the rights of people using health and disability services;
• monitor, report on and improve the quality of our complaints process.

When a complaint is made about a person or organisation, they must be given a fair opportunity to consider the complaint and respond. Normally we send the information in your complaint to the relevant people for their response.

WE PROTECT YOUR PRIVACY
You have the right to ask for a copy of any personal information we hold about you, and to ask for it to be corrected if you think it is wrong.

We may provide information we receive from you, and from your health or disability services provider, to a health and disability advocate. Often we ask advocates to talk through resolution options or to help with clarifying or resolving complaint issues.

Sometimes HDC creates case studies for publications and presentations. We may use a complaint you are involved in for a case study. If we do, we remove names and places.

THE INFORMATION WE COLLECT AND THE PRIVACY ACT
When we collect, use, and share personal information we comply with the Privacy Act and the Health Information Privacy Code. This includes personal health information.

Step 1 - About You

Please select a title from the drop-down list
Please enter your first name(s)
Last Name is required
Please enter your address
Specify your preferred method of contact:
Tell us which method of contact you would prefer
Please specify the preferred method of contact

Step 2 - Your Complaint

A service provider needs to be entered here
Please select at least one provider type
Provider address needs to be entered here
Please specify the relationship between you and your provider

Step 3 - What Happened

Tell us what you want to complain about. Be clear, and focus on the main problem(s).

Describe the events you want to complain about.

We need to know:
- what happened;
- who it happened to;
- when it happened (the date and time);
- where it happened; and
- who did it (person or organisation).

You can attach files, such as photos and documents, here. Each file will need to be attached separately.

This is a required field.

Step 4 - Tell us more about your complaint

Other Agency/Agencies: Have you made a complaint to another agency about this matter (for example, ACC, the Human Rights Commission, the Privacy Commissioner, the Police)?
Please select one option

5. Demographics

This information is collected to help us improve our complaints process and will be kept confidential. If you do not want to provide this information it will make no difference to how we handle your complaint.

Age Group
Gender:
Please specify gender
You need to specify at least one option

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