Allegra Complaints / Feed Back 
Please complete this form to file a complaint or give feedback about our people, processes or problems we can work with you to resolve.  We will respond to your feedback as soon as possible to find a resolution.  
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Name *
(First / last) Please input your first and last name
Confidentiality *
Do you wish for your identify to remain confidential?
Contact No. *
Best contact number to assist us to respond to your complaint
Contact Email *
Preferred Contact Method *
Date & Time of the incident *
MM
/
DD
/
YYYY
Time
:
Nature of Complaint *
Complaint Against
If the complaint is against a specific person, please include their full name.  Leave blank if none
Details of Complaint *
Describe the issue in detail / include names, dates and any relevant information
Impact of Complaint *
Explain how the issue has affected you or someone else
Resolution Requested *
What outcomes are you seeking?  How could this complaint be resolved?
Supporting Documentation
Do you have any supportive documentation you could provide that you would like to add?  emails, notes, etc)
Witnesses
Are there any witnesses to the incident? / If yes, please provide their names
Previous Action Taken *
Have you taken any steps to address the issue?  If yes, please describe.  
Preferred Resolution Method *
Comments
Is there any further you would like to add?
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