Feedback and incident form

In the event of a health emergency please contact 000

Please complete this form to provide feedback or report a clinical incident relating to either:

  • the Queensland Community Pharmacy Scope of Practice Pilot
  • the Queensland Community Pharmacy Hormonal Contraception Pilot

Share a compliment
If you are happy with the treatment you received or something or someone has impressed you, please share this with the pharmacy staff as well as through this form.

Make a complaint
If you are not happy with the treatment you received, you have a right to express your concern and to have this heard and acted on.

To make a complaint, the following steps are recommended.

Go local first: contact the pharmacy in question. Talking to the pharmacist or pharmacy owner is often the easiest and quickest way to resolve the problem.

Act quickly: talk to someone as soon as possible, as the longer you wait the less clear the facts become and the harder it can become to find a solution.

Make it clear: provide detailed information and explain what action you would like the pharmacy to take. If possible, the following information should be provided:

  • describe what occurred
  • explain the order in which things happened
  • include dates where possible
  • list any phone calls, letters or meetings
  • provide any supporting documentation that may help us address your concern

Make a formal complaint: If you do not wish to talk about your concerns with local staff or they have not been able to address your concerns, you can make a formal complaint using the form below.

You can contact the Queensland Ombudsman or the Office of the Health Ombudsman, depending on the nature of your complaint. These organisations provide external review and investigation of complaints, where appropriate.

Privacy

Personal information collected by the Department of Health is handled in accordance with the Information Privacy Act 2009. The Department of Health is collecting personal information in order to appropriately inform implementation activities and quality and safety management and reporting for the Queensland community pharmacy pilots.

All personal information will be securely stored and only accessible by authorised employees of Queensland Health (or its agents). Your personal information will not be disclosed to other third parties without consent, unless disclosure is authorised or required by or under law.

For information about how the Department of Health protects your personal information, or to learn about your right to access your own personal information, please see our website at www.health.qld.gov.au

Required fields are marked with an asterisk (*).

Do you want to remain anonymous? *

Please note, clinical incidents cannot be reported anonymously. Identifiable details must be included to enable appropriate action to occur in response to a clinical incident. By providing this information, you consent to the information being used to appropriately respond to reported clinical incidents.

Selecting to remain anonymous may limit our ability to comprehensively investigate your feedback, however all feedback will be recorded and reviewed as appropriate.
Would you like to *
Are you a *
Do you have a preferred method of contact? *
This can be located on your referral documentation and consultation summary.
Do you have the patient’s consent to report this incident and disclose their personal details? These details may include their encounter ID and specific incident details.
This can be located on the referral documentation and consultation summary
Please include as much detail as possible and explain what action you would like the pharmacy to take. If possible, the following information should be provided:
  • describe what occurred
  • explain the order in which things happened
  • include dates where possible
  • list any phone calls, letters or meetings.
Please include as much detail as possible about the suggestion for improvement. This may include clearly describing the proposed improvement or providing examples as to how your suggestion may be implemented.
Please include as much detail as possible relating to your feedback and explain what action you would like the pharmacy to take. If possible, the following information should be provided:
  • describe what occurred
  • explain the order in which things happened
  • include dates where possible
  • list any phone calls, letters or meetings.
Please include the pharmacy name and pharmacy address.
Please list the name and address of the participating pharmacy (if applicable):
Has this feedback been shared directly with the pharmacy? *
Has this feedback been raised directly with the pharmacy or with any other organisation? * For example: 13 HEALTH, Office of the Health Ombudsman.
Has this incident been raised directly with the pharmacy or with any other organisation? For example: 13 HEALTH, Office of the Health Ombudsman.
Are you willing to be contacted by Queensland Health if further information relating to your feedback is required? *
Would you like a response in relation to the feedback provided?

Last updated: 6 June 2024