Health Officer Complaint Form

Please complete the form below to initiate a complaint. Please include all requested information, including name, phone number, and e-mail address. If this is an emergency situation (sick or ill subjects), please call 911 and have an ambulance respond.

Thank you.

Complainant Name: *

Complainant Phone Number: *

Complainant Address: *

Complainant Email Address:

Complaint: *

Location of Property in Question: *

Other Pertinent Information (landlord info, etc):

Security Measure