Appeal Form

By completing this form, you are requesting to appeal the decision pertaining to your complaint to Medilife Pty Ltd. This form must be submitted to the CEO of Medilife Pty Ltd within 7 working days of you receiving the complaint decision to begin the appeal process. The matter will be deemed closed and settled if no response is lodged within 7 working days.

A reply will be emailed to you within 7 working days.

Appeal Form

Name *

Date *

Email *

Phone *

You have the right to select a mediator to represent your concerns or have no representation.

Mediator required? *

Yes, mediator required

No mediator required

Name of mediator

In the box below, please provide as much information as possible, and detail all aspects and concerns in full for your reason to appeal the complaint decision.

Reason to appeal *

Extra information can be added along with this form if required.

Maximum upload size: 2.1MB

I hereby declare that all details in this request are true and accurate.

Signature *

Sydney’s Leading Provider of First Aid Solutions

Appeal Form

You have the right to select a mediator to represent your concerns or have no representation.

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