Feedback Form

Your Name (required)
Date Submitted (required)
What is your email address? (required)
Preferred contact number (during business hours)*
Positive Feedback
Negative Feedback or Complaint
What is your complaint about?
What disappointed you?
Name/s of staff, or service provider concerned:
Location (where applicable):
When did it happen?
Is this a high risk or safety issue? YesNo

(If yes, please say why)
Immediate action recommended (if any, eg, to ensure safety and prevent harm to any person)
Are there any other comments you would like to make?
What action would you like White Spot Group to take?