Public Health Complaint Form
Once a complaint is filed with our office it becomes a public record. Anyone may obtain a copy of a complaint file upon request. This will include any contact information that you choose to provide.
Sign in to Google to save your progress. Learn more
What is the nature of the complaint? *
Facility Name
Where is the public health complaint located? *
Address
Description of public health complaint: *
Is this a rental property?
If this is a rental property is the tenant in the processes of being evicted?
Clear selection
When were these conditions observed? *
MM
/
DD
/
YYYY
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy