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?
When were these conditions observed?
MM
/
DD
/
YYYY
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