Retirement village complaint form

Use this form to make a complaint about a retirement village. Anyone can use this form including non-residents.

Please have any details about your complaint ready to provide as much information as possible.

It takes about ten minutes to complete this form.

  1. Name
  2. Your contact details
  3. Address
  4. Language assistanceIf you are from a non-English speaking background, do you need a translator to discuss your complaint?
  5. (If you chose ‘Yes’ above)
  6. Your complaint
    1. Have you complained to the provider, a Government department or another agency about this issue? *
    2. Complaint history (If you chose ‘Yes’ above)
  7. Supporting documentsIf you have any supporting documentation (e.g. emails, letters, receipts) for your complaint, please attach the files below. If you do not have the documentation right now, you can email us at regulatoryservices@chde.qld.gov.au

    Attach file:

    Attach file:

    Attach file:

  8. DemographicsWe use this information to better understand our customers and how we can improve our services. You can complete this section in full, in part or not at all.
    1. Gender
    2. Age
    3. Employment status
    4. Background Select all that apply
  9. Declaration

    If your complaint is resolved after lodgement of this form, please advise us at regulatoryservices@chde.qld.gov.au as soon as possible.

    I declare that the information supplied by me is, to the best of my knowledge, true and correct. I agree that the information provided (except for demographic data) may, if necessary, be revealed to the trader in correspondence or investigations concerning this complaint or referred to another authority for their appropriate action should the matter fall outside this department's jurisdiction

  10. Agreement * (if you do not agree, we will not accept your complaint)