[div class="container"]
[div class="form-wrap"]
[form id="survey-form"]

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[label]Source[/label]
ParticipantWorkerNDISOther
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[div class="col-md-12"]
[p]Part A – About me (If you want to raise this complaint anonymously, DO NOT complete this section)[/p]
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[div class="row"]
[div class="col-md-12"]
[div class="form-group"]
[label id="name-label"]Full Name[/label]

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[div class="col-md-6"]
[div class="form-group"]
[label id="email-label"]Date[/label]

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[div class="col-md-6"]
[div class="form-group"]
[label id="phone-label"]Phone Number[/label]

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[div class="col-md-12"]
[div class="form-group"]
[label]Address[/label]

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[/div]
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[div class="row"]
[div class="col-md-12"]
[div class="form-group"]
[label]Is there someone else (legal representative or support person) that you would like involved in making this complaint?[/label]
YesNo
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[/div]
[/div]

[div class="row"]
[div class="col-md-12"]
[div class="form-group"]
[label id="legal-representative-label"]Name of legal representative/support person[/label]

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[/div]
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[div class="row"]
[div class="col-md-12"]
[p]Part B – Your complaint[/p]
[div class="form-group"]
[label]What is your complaint about?[/label]

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[div class="col-md-12"]
[div class="form-group"]
[label]How can we help to fix this problem or complaint?[/label]

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[div class="row"]
[div class="col-md-4"]

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[/form]
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