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Feedback Form
Feedback Form
Share your compliments, complaints and suggestions with us.
Are you happy to recommend us to your family and friends?
9-10 Very Happy
7-8 Happy
5-6 Neutral
3-4 Somewhat Unhappy
0-2 Very Unhappy
Which service does your feedback relate to?
(Required)
Please select from the list below:
Dental
Counselling
Child Health Services
Aged Care
Adult Allied Health
Which BHN site does your feedback relate to?
(Required)
Please select from the list below:
Bentleigh East
Chelsea
Cheltenham - Bay Rd
Cheltenham (NDIS Disability Support Centre)
Clayton South (NDIS Disability Support Centre)
Edithvale (NDIS Disability Support Centre)
Parkdale
Prahran
South Melbourne
St Kilda
Do you have any comments about the feedback you have given above?
Do you identify as any of the following?
This question is optional, you do not have to answer it. We ask for this information so that we can continue to change and improve our services to best meet the needs of our community.
Aboriginal or Torres Strait Islander
Multicultural
Multifaith
LGBTIQA+
Refugee and Asylum Seeker
Person living with a disability
Person experiencing homelessness
Person living with mental illness
Prefer not to say
Would you like us to contact you about your feedback?
If you select yes, please provide your name and contact details below before submitting this form.
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No
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