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.
What is the nature of the complaint? *
Facility Name
Your answer
Where is the public health complaint located? *
Your answer
Address
Your answer
Description of public health complaint: *
Your answer
Is this a rental property?
If this is a rental property is the tenant in the processes of being evicted?
When were these conditions observed? *
MM
/
DD
/
YYYY
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