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Contact Details
Complaints process
Complaints
Thank Ambulance Victoria
Complaints
More information about the complaints process is available
here
Date (dd/mm/yyyy Eg: 25/09/1983) :
About you the complainant
First and last name :
•
Address (please include: street number, street name, suburb and postcode) :
Telephone (BH):
Telephone (AH):
Email :
•
Gender :
Male
Female
First language :
Date of birth (dd/mm/yyyy Eg: 25/09/1983) :
Are you filling this complaint form on behalf of someone else?:
Is this person aware that you are complaining on their behalf? (Please note AV may need the patient's consent to investigate particular aspects of the complaint):
Yes
No
What is your relationship to the person for whom you are making the complaint?:
About the patient (only complete if you are complaining on behalf of someone else)
First and last name:
Address (please include: street number, street name, suburb and postcode):
Telephone(BH):
Telephone(AH):
Gender:
Male
Female
Date of birth (dd/mm/yyyy Eg: 25/09/1983) :
First language:
Details of the event complaint is related to
Date of event:
Time of event:
Location of event:
•
Invoice number (if applicable):
Brief description of complaint:
•
What outcome are you seeking?:
Have you previously complained about this matter?:
•
Yes
No
If yes, to whom have you complained and when?:
Are you a member of Ambulance Victoria?:
•
Yes
No
If yes, what is your membership number?:
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