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Foodborne Illness Complaints

Basic info

Thank you for reporting your illness to Public Health - Madison & Dane County (PHMDC). Please enter the following information as completely as possible. The more information you enter, the better we can follow up on your complaint. Someone may contact you if we need more information.

This form is for restaurants and stores in Dane County only. If you think a restaurant or store in a different county made you sick, please contact the health department in that county.

This should take less than 10 minutes to complete.

All information you enter will remain confidential. We will not give your name to the restaurant or store.
This question requires a valid email address.
5. Restaurant or store address: *This question is required.
This question requires a valid date format of MM/DD/YYYY.
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8. Who are you completing this form for? *This question is required.