Complain about care you received

1. About You2. Your Complaint3. What Happened4. More Info

Tell us a little about yourself

My personal details
Which ethnic group do you belong to * Please select all that apply.

Do you identify as having a disability? *

Do you have difficulty with any of the following? * Please select all that apply.

Do you have any accessibility needs? * For example: “I prefer documents in large print”; “Please talk loudly and clearly as I have a hearing impairment”.

Do you know your NHI number? * The National Health Index number is a unique identifier given to every person who uses health and disability services in New Zealand.

My contact details
What is the best way to contact you? *