Health Department Inquiry Form

Inquiry Information

Do you have a question, concern, or complaint? Please complete and submit the form below. One of our team members will follow up within two business days.

1. Person Submitting Form: *This question is required.

2. Contact Information:

Phone Number *This question is required.

Email Address *This question is required. This question requires a valid email address.

Street Address

City

State

Zip

3. Type of Inquiry: *This question is required.

4. Address of Complaint (if applicable):

5. Business Name (if applicable):

6. License Number (if applicable):

7. Nature of Inquiry: *This question is required.

PLEASE NOTE: This form is not a FOIA Request Form. If requesting information, complete this form or call (269) 673-5411