Please fill out this online complaint form for any concerns dealing with public health violations.

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How long has the condition existed? *

Environmental Services

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Complaint Form (Online)

Email - Person requesting the investigation: *

Was this condition reported to another agency?

Yes

Was this condition reported to the health department previously? *

Yes

Name - Person requesting the investigation: *

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What Agency?

When? *

I herein request an investigation of the public health hazard or nuisance described below: *

By making this request for an investigation, I acknowledge that the health department may take all neccesary steps consistant with the appropriate laws to investigate and effect correction if such is warrented. Such action may involve referral to other agencies or legal action that may require the need for court appearance and testimony to collaborate the conditions stated in this complaint. *

Yes

Date and time: *

Location (be specific): *

Address - Person requesting the investigation: *

Name - Owner of Property (if different):

Phone - Owner of Property (if different):

Phone - Person(s) Responsible for the Condition: *

What's Happening

Name - Person(s) Responsible for the Condition: *

Address - Owner of Property (if different):

Healthy Corner

Phone - Person requesting the investigation: *

Environmental Services

Complaint Form (Online)

What's Happening

Healthy Corner

call us at:

(304)799-4154