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Health and Human Services Department

Food Establishment Complaint Intake Form

Complete the boxes below. When you have completed the form, click on submit and your form will be sent to the Bureau of Consumer Health.

  My complaint is on a ...
Fast Food Place
Mobil Unit (taco stand, etc.)
Illegal Vendor
Ice Cream Truck
Which other?
  Name of establishment ...
  Physical address of establishment ...
Providing information in this dark gray box is optional
Your name:
Your phone:
Your e-mail:

Please provide a description of your complaint/comments (Please provide food safety specific description rather than monetary or behavioral issues): ...


Mobile Unit Information 1

If this complaint is on a mobile food unit/vehicle/illegal vendor, include a detailed description of the mobile unit/vehicle and the license plate number:


Mobile Unit Information 2

Days and time of day that the mobile unit/vehicle/illegal vendor was observed: