Ombudsman Western Australia Serving Parliament - Serving Western Australians

Which agency do you wish to make a complaint about? *

Please give specific details about your complaint. *

If you have contacted the agency, what was its response?
If you can, please include the name of any person in the agency you have dealt with, and any agency reference.

What do you think should be done to fix the problem?

Have you submitted your complaint anywhere else, if so where?

If you want to send a relevant document electronically, please use the browse option below to attach a document to this form:
Send this file:

I will be sending relevant documents that support my complaint by post.

Family name: *

First Name(s): *

Title:

select a title Mr Mrs Ms Dr Other Other (please specify):

Gender:

Male      Female

Age:

Your email address: *

Address: *

State:

Post Code: *

Telephone:

(daytime)
(mobile)

Is this complaint on behalf of another person or on behalf of a company or organisation?
No      Yes

If yes, what is the name of that person/company/organisation?

Does that person/ company/ organisation know that you are submitting this complaint?
No      Yes

Please indicate if you (or the person you are making the complaint on behalf of):

identify as Aboriginal or Torres Strait Islander.
No       Yes

speak a language other than English at home.
No       Yes which language?

have a disability or special need.
No       Yes what is your special need?