Complaint Form

Making sure you are heard

Kia ora – Thank you for visiting Hemisphere Health. We value you and want to ensure that your concerns matter. Fill out the form below and we will be contact as soon as possible.

Complaint Form

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Details of person making complaint

Name

First Name

Last Name

Date

Address

City/Town

Region

Postcode

Phone

Preferred method of contact

Phone

OtherOther

Are you the client (the person receiving the services)?

Yes

Details of client you are assisting

Name

Date of birth (day/month/year)

Your relationship to them:

If you are human, leave this field blank.