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Translating and
Interpreting Service (TIS)
13 14 50

National Relay Service
13 36 77
(then ask for 02 9281 3600)

Office Hours
9am - 4:30pm

Complaint Form

Seniors Rights Service invites any person who is not satisfied with the service that has been provided to them to express their concerns. This communication is strictly confidential.

You may do this by completing the form below, telephoning Seniors Rights Service (02 9281 3600 or 1800 424 076), or by writing to Seniors Rights Service, Lvl 4, 418A Elizabeth St, Surry Hills, NSW, 2010.

Your concern will be taken seriously and you will be contacted about the issue by a Seniors Rights Service manager.

Your Details
Name
First Last
Organisation
Address
Street Address Address Line 2 Town or Suburb State Postcode
Phone No.
Fax No.
Email
Details of person acting on behalf of complainant (if applicable)
Person to be contacted (if different from above)
First Last
Service description
Name of Seniors Rights Service staff member who provided your service
First Last
Reference number of service
Enter your reference number if known. You would only have a reference number if you received correspondence from Seniors Rights Service.
Description
Problem encountered
Date of occurrence
Description
Remedy requested
- Yes
- No
What remedy would you like to have done?
Enclosures
Upload any documents you would like considered as part of your complaint.
Phone
This field is for validation purposes and should be left unchanged.

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