Suggestions, Compliments or Complaints

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Filling in this form will not affect the quality of care you receive from Te Rarawa either now or in the future. Everything will be treated with CONFIDENTIALITY.

Complaint/Concern
Compliment
Suggestion

First Name

Last Name

Date of event

April 2024
	S	M	T	W	T	F	S
14	31	1	2	3	4	5	6
15	7	8	9	10	11	12	13
16	14	15	16	17	18	19	20
17	21	22	23	24	25	26	27
18	28	29	30	1	2	3	4
19	5	6	7	8	9	10	11

Time of event

Time picker
Time Picker
12:00 AM	1:00 AM	2:00 AM
3:00 AM	4:00 AM	5:00 AM
6:00 AM	7:00 AM	8:00 AM
9:00 AM	10:00 AM	11:00 AM
12:00 PM	1:00 PM	2:00 PM
3:00 PM	4:00 PM	5:00 PM
6:00 PM	7:00 PM	8:00 PM
9:00 PM	10:00 PM	11:00 PM

No
Yes

Event/activity

What happened

What happens now

	S	M	T	W	T	F	S
14	31	1	2	3	4	5	6
15	7	8	9	10	11	12	13
16	14	15	16	17	18	19	20
17	21	22	23	24	25	26	27
18	28	29	30	1	2	3	4
19	5	6	7	8	9	10	11

	S	M	T	W	T	F	S
14	31	1	2	3	4	5	6
15	7	8	9	10	11	12	13
16	14	15	16	17	18	19	20
17	21	22	23	24	25	26	27
18	28	29	30	1	2	3	4
19	5	6	7	8	9	10	11

	S	M	T	W	T	F	S
14	31	1	2	3	4	5	6
15	7	8	9	10	11	12	13
16	14	15	16	17	18	19	20
17	21	22	23	24	25	26	27
18	28	29	30	1	2	3	4
19	5	6	7	8	9	10	11