Australian Zionist Health Care Alliance

Victim of a vexatious complaint form

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Personal Details

First name

Last name

Your profession

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Complaint Details

Date vexatious complaint was received (e.g., MM/DD/YYYY or approximate month/year)

Location of the complaint (e.g., hospital name, state, or other relevant details)

Time it took for resolution to be reached (e.g., number of days, weeks, or months; please note if the issue is still ongoing)

Brief summary of the vexatious complaint (describe the nature of the complaint, including any antisemitic or antizionist elements)

Other relevant information (optional – any additional context or related incidents)

Impacts (optional)

Adverse outcomes (e.g., professional repercussions like suspension, warnings, or career setbacks)

Approximate financial impact (e.g., lost income, legal fees; provide an estimate if known)

Psychological impact (e.g., stress, anxiety, or other effects; we understand this may be sensitive)

Class Action Interest

Are you interested in joining the class action?

Yes. I want to attend an online seminar outlining next steps of the class action.

No. My de-identified complaint details will be added to the National Register.

Privacy Assurance: Your submitted details will be accessible only to the AZHA executive board and will not be shared without your explicit written consent.