Confidential Online Complaints Form

Therapy ACT respects the rights of clients to have their complaints investigated promptly with impartiality and confidentiality.

This form can be completed online and submitted directly to Therapy ACT. 

Name:           

Address:        

Telephone No: (please include area code)

Home:    Business:     Mobile:  

Details of Complaint

Recommended Action:
What would be regarded as a satisfactory action and/or outcome?

I would like to receive a response by:

•  Telephone
•  Email

If you have checked the email box above box please supply an email address: