File a Complaint
Please use this form to notify NKY Health if you feel a Dayton business is in violation of the Dayton Smoking Ordinance.

To ask a general question, please use the form at: https://forms.gle/FJDoH1Bhng9Frv3Y8
Sign in to Google to save your progress. Learn more
Date Witnessed *
MM
/
DD
/
YYYY
Approximate Time Witnessed *
Time
:
Type of Problem *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Northern KY Health.

Does this form look suspicious? Report