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CQ Health - Have your say

Central Queensland Hospital and Health Service welcomes and appreciates your feedback. It helps us to improve our health services for you and your community.

Please complete the fields below to help us help you.

We take your privacy seriously.  There will be no record of your feedback attached to your medical chart.  Feedback is treated with confidentiality at all times.

Section 1: About you
Do you want to remain anonymous? * Choosing to remain anonymous may mean we cannot fully investigate your feedback, however all feedback will be recorded and reviewed.
Are you providing feedback on behalf of someone else?
What is your relationship to this person?
Do you have permission to provide feedback on the patient's behalf?
Section 2: The patient/consumer
Patient's date of birth
Does the patient require assistance due to the following?
Does the patient identify as Aboriginal and/or Torres Strait Islander?
Section 3: Feedback
What type of feedback would you like to give?
Date of event *
Please provide as much detail as possible.
What outcomes are you seeking?
How would you like CQ Health to respond to you?
Submit your feedback
Information disclaimer and consent * While Queensland Health endeavours to ensure that the online transmission of the form, containing your information, over the internet is secure, the inherent nature of the internet means that there is a potential risk that your information may be viewed or intercepted by third parties. Accordingly, submission through the online form shall be at your own risk and Queensland Health accepts no responsibility or liability for any unauthorised access to your information contained in the form when it is submitted online over the internet. It is inadvisable to complete this form on a public or shared computer. If a public or shared computer is used then this shall be at your own risk, and you must take all reasonable steps to ensure your confidential information does not remain on the computer or in any way accessible by a third party. Individuals who submit the form online should receive an acknowledgement from Queensland Health that the form has been sent, on the screen, following submission. Queensland Health accepts no responsibility or liability if this acknowledgement does not appear or we do not receive your online submission. You acknowledge that you have read and understood Queensland Health's Privacy Statement and Disclaimer.
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Last updated: 6 January 2020

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