Feedback & Complaints Form

Please be assured that all information is strictly confidential.

DMI Psychology is committed to continually improving the quality of our service, and we encourage you to provide any feedback or complaints you have to us using this form. Please be assured that all information is strictly confidential. If you feel unsure about anything or would like help to complete this form, please email [email protected] or contact our Principal Psychologist on 0414 992 492.

Personal Details

The information provided below will be used to contact you. Only provide the contact details that you wish to be contacted on.

Details of Complaints

Is the complaint related to:

Employee of DMI PsychologySpecific Incident

Service DeliveryOther

(Include date if possible)

(List all persons involved and witnesses if applicable)

(Inform the witness that they may be contacted DMI Psychology to discuss the matter)


Additional information/supporting documentation

Please attach copies (not the original) of any documents that may help us to handle the complaint, e.g. if you have
letters, emails, faxes or records of conversations you have had with the person/s associated with the complaint. To
help us resolve this matter as fast as we can, please ensure your contact details are kept up to date. If any of your
details change please let us know as soon as you can.

Form Submission*

This form collects personal and detailed information for the purposes of managing a feedback or complaint against
DMI Psychology services or providers. This information may also be used for the continual improvement of our
service, as well as any disciplinary measures required to address the feedback or complaint. Your information is
bound by the relevant Australian privacy legislations. and will be recorded in accordance with our legal obligations.
By submitting this form, you confirm that you understand how your information will be managed, and for the Principal
Psychologist to contact you in order to come to a resolution.

I AgreeI Disagree