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									                                            Speak Out!

                                                            Do you have something to say
                                                            about ORYGEN Youth Health?

                                                                                                                                 Follow the instructions on this

                                                                                                                                                                                                         ORYGEN Youth Health
                                                                                                                                 form to have your say…

                                                                                                                                                                                                                               Phone 9342 2800
                                                                                                                                                                                                         35 Poplar Road
                                                                                                                                                                                                         Parkville 3052

- stiffness: cross direction of 14 to 1140 mN.                                                                                                                                                          rection of 1.5mN.
- stiffness: machine direction of 30 to 1140 mN; an                                                                                                                                                       direction of 3 mN; and,
- thickness of 0.18 to 1.5 mm;
- weight of 140 to 500 gsm;
Summary: Card or Single Sheet Requirements:
                                                                                                 bottom 20 mm of the reverse side.
                                                                                           Note: No print content can appear in the
                                                                                                                                                                                                        to 0.18 mm;
                                                                                                                                                                                                         0 gsm;
                                                                                                                                                                                                         pe Paper Requirements:
                                                                                                                                                                                                                                    Youth Health
                                         17/09/2001 11:34:25 am                                                                                                              Filename: S4185686800495210Y010917.pdf
                                                                                                                          PARKVILLE VIC 3052
                                                                                                                          Reply Paid 72081
                                                                                                                          ORYGEN Youth Health – FEEDBACK
                                                                                                                     PARKVILLE VIC 3052
                                                                                                                     Locked Bag 10                                                         Speak Out!
                                                                                                                     Delivery Address:
         if posted in Australia
          No stamp required
                                   Note: The artwork cannot be scaled.                                                                                                            Width: 95 mm X Length: 210 mm
                                   Note: All components must be printed.                                                                                                          Font colour: Black only
                                                                                                                                                           Office use only
               Yes I would like to hear from the service about my feedback                                                                                 Feedback Duty Worker ____________________________________
               Name: ____________________________________________                                                                                          Date Received ___________________________________________
                                                                                                                                                           Feedback acknowledged __________________________________
               Address: ___________________________________________
                                                                                                                                                           Date & Details __________________________________________
          correct addressing and formatting standards will result in the customer being ineligible for the discounted Reply Paid small letter rate.        Feedback resolved _______________________________________
               Phone: ____________________________________________
          etails below the barcode. Contact Australia Post if any changes are required.
         responsibility to check that the artwork is correct and to provide the printer with authority to pro                                              Date & Details __________________________________________
                                                                                                            ceed with printing. Please check the delivery address
               If you are not happy with our action in response to a complaint,
               you have the right to raise the issue with the:
                                                                                                                                                           Feedback forwarded to coordinator _________________________
               Health Services Commissioner
                                                                                                                                                           Date & Details __________________________________________
               30th Floor
               570 Bourke Street
                                                                                                                                                           Feedback Resolution
               Melbourne 3000
                                                                                                                                                           Action to resolve feedback ________________________________
               Phone: 8601 5200
                                                                                                                                                           Date & Details ___________________________________________
What do I do?
1 Write your comments in the feedback section.
2 If you would like a personal response, turn this
  form over and fill in your contact details in the
                                                            Speak Out! – feedback form                                                Your Say
  space provided.                                           Are you a       ❑   young person who uses the services of ORYGEN Youth Health.
3 Return this form by folding it then either:                               ❑   family member or friend of a young person who uses the services of the program
   • Hand it to a case manager or nurse                                     ❑   staff member on behalf of an anonymous young person or family member
   OR                                                                       ❑   external service provider
   • Place it in the red letterbox in the reception area.                   ❑   other (please specify) _________________________________________________
   • Detach the feedback section, moisten adhesive          Do you have a ❑     comment         ❑    suggestion      ❑    complaint
     strip and seal the feedback form. Drop it in the
     mail – no stamp needed.                                Which part of ORYGEN Youth Health is your feedback about?
                                                               ❑   Reception      ❑    YAT                    ❑    EPPIC Outpatient          ❑    EPPIC Inpatient

What happens next?                                             ❑   Youthscope     ❑    Group Programs         ❑    PACE                      ❑    IMYOS

If you have given us a comment or suggestion, it will          ❑   Triage         ❑    M/Health Promotion ❑        EPPIC Statewide           ❑    Compass
be reviewed by management and may be acted on                  ❑   Research       ❑    Other (please specify) ______________________         ❑    Not sure
them or by the co-ordinator of the specific program.
If you have submitted a complaint, it will be for-          What would you like to tell us?
warded directly to a member of the management               __________________________________________________________________________________________
team for prompt action. Making a complaint will
not disadvantage you or any young person.                   __________________________________________________________________________________________
You can write in any language, we will translate the        __________________________________________________________________________________________
feedback.                                                   __________________________________________________________________________________________

YOUNG PEOPLE – to find about being involved                 __________________________________________________________________________________________
in the development of ORYGEN, call the Youth
Participation Worker at ORYGEN Youth Health:                __________________________________________________________________________________________
Ph 8346 8209.                                               __________________________________________________________________________________________
FAMILIES – you can find out more about family               __________________________________________________________________________________________
support groups by calling the Family Participation          __________________________________________________________________________________________
Worker at ORYGEN Youth Health Ph 9342 2800.
out more about how ORYGEN Youth Health are                  Would you like a response from ORYGEN Youth Health about what happens with your feedback?
working with the community by calling the Mental
Health Promotion and Partnerships Co-ordinator                 ❑   Yes – Don’t forget to fill in your contact details on the back of this form.
Ph 8346 8222                                                   ❑   No – I just wanted to let you know

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