Form

Our Feedback and Authority to Disclose Information Form allows you to provide feedback while granting us permission to disclose relevant information for prompt resolution and improvement.

If you don't have a complaint or feedback about a specific service and you are experiencing any other issues please go here so we can address your query.

Alternatively, you can provide anonymous feedback or disclose your information by completing this form or by contacting us directly via the Chat Bubble at the bottom of the screen.

First Name*

Last Name*

Mobile phone number

Email*

Name of your employer*

Type the name of your Employer (Company name)

Name of Professional or person who provided the service (if applicable)*

What type of appointment did you have?*

Date of appointment

Month/Day/Year

Describe in detail the nature of your feedback, including all individuals involved*

Please add any specific information that will help us better resolve your query such as device used, browser used, version of your browser, where is the issue happen, when, what actions you are taking that result in the issue, be as descriptive as possible.

Feel free to upload any documentation, screenshot or video that will help us understand further the feedback.

I consent that my feedback and related communications may be disclosed to the following people:

-Manager / Point of Contact for Kara Connect within your Organisation (Employer) -(e.g) Line Manager, Decision Maker, Day to Day Operations, or related contact.
-Professional or person that provided the service.
-Any other stakeholder that may relate to this case.

I consent that my feedback and related communications may be disclosed as part of this submission.*

I declare that the above information is true and correct.