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.

Health Officer Complaint Form

Complainant Name:

Complainant Phone Number:

Complainant Address:

Complainant Email Address:

Complaint:

Location of Property in Question:

Other Pertinent Information (landlord info, etc):



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