File A Food Service Establishment Complaint
 

To file a Health related complaint against a food service establishment, please complete the form below and click the 'Submit' button at the bottom of the page.  All fields are required unless noted as optional.  To file a complaint on any matter besides a food service establishment, click here.

 

Note that this form is to be used to report situations in Miami County, Indiana only.  To file a report in other counties and states, please contact your local Health Department as requests for outside of Miami County, Indiana that are sent here will not be processed.

  Establishment Name
  Establishment Address
  Date Complaint Observed
  Time Complaint Observed
   Nature of Complaint
If the complaint is an illness, be sure to submit your name and daytime phone number, a department representative will contact you.  Do not submit any medical information.
List the Complaint (Your Observations About the Complaint)
Was food or beverage consumed in the establishment or carried out?
What exact food item(s) involved?
  Complainant's Name (Optional)
 Complainant's Daytime Phone (Optional)
  Complainant's E-Mail (Optional)
Complainant's Address (Optional)

Note that this form is to be used to report situations in Miami County, Indiana only.  To file a report in other counties and states, please contact your local Health Department as requests for outside of Miami County, Indiana that are sent here will not be processed.


 

To file a health related complaint on any matter besides a food service establishment, click here.


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