Form Test 1

Hi,

Please tell us about your complaint. We will take your complaint seriously and get it resolved for you. We are so committed to getting a result for you that we guarantee you'll be contacted by the deadline you agree to.

It will take you less than 60 seconds

So let's get started...

Which best describes your level of concern?

Not fussed

Frustrated

Annoyed

Angry

Outraged

Vengeful

What has been the impact of this issue. (Select all that apply)?

I've lost productive time at work	It has caused stress and/or anxiety
I've lost personal time over it	No impact to me but I want to help others
It's an inconvenience	I've lost business
It has cost me money	Other

What outcome do you want?
(Select at least one outcome)

Give more details or information about any other outcome(s) you want. (Optional)

Thank you, now we need a few details.

* Which of these best describes your issue?
(Select all that apply)

Billing/account	Service connection/disconnection
Meter issue	Need extra time paying bill
I have been informed legal action is underway

Please select an option from the drop down menu below. After selecting an option, another drop down list will be displayed below. Select an appropriate option from that list as well.

Describe the issue in your own words (optional)

Provide the address relating to the issue.

Address 1 :

Address 2 :

City :

State :

Post code :

Prior Response Not Loaded - Please Insert a Page-Break Before the Custom Logic Script

However, if you need a response sooner, please tell the date (optional)

And so we know how to contact you, please provide your details

Your contact details

First Name :
Last Name :
Email Address :

I agree to receive news & offer emails from HandleMyComplaint.com.au

Phone :

I understand handlemycomplaint.com.au handles my complaint with a range of participating suppliers. By entering my telephone number I agree that Handle My Complaints's trusted partner, may contact me to further assist with my complaint needs.

I am making contact on behalf of
Making contact on behalf of someone else may require signed, written permission.

Myself

Someone else

Someone else
What is your relationship to this person?

Title

First Name :
Last Name :

Almost done, last few questions are optional but will assist with your complaint.

When did the issue FIRST occur? (Optional)
(Select one only)

How many times have you contacted the organisation directly about the issue (Optional)

I haven't contacted the organisation. I’m using this system to lodge the complaint for the first time

1

2

3+

Other

Why haven’t you approached the organisation directly? (Optional)
(Select all that apply)

My complaint is urgent

I don't want to

I won't get the result I am after

They have gone out of business

Other

If you have contacted any other organisation with regards to this complaint, please tell us which one(s).

Handle My Complaint

Ombudsman

Fair Trading/ Consumer Affairs

Hired a solicitor

The media (eg. tv, radio, newspaper)

Social media (e.g Facebook, Twitter)

Another government agency

Describe your customer service experience with the ombudsman, fair trading or another government agency (Optional)
(Select all that apply)

Issue will take too long to resolve

The staff member was nice but couldn't assist

Uninterested staff

Rude staff

Promises made but not followed through

Email not returned

I'm still not happy with the result

Staff were professional but couldn’t resolve due to policy

Other