File a Complaint

Step 1
Select a complaint type
Step 2
Enter facility information
Step 3
Enter complaint information
Step 4
Review and Submit

Select the type of complaint that you will be submitting.

An asterisk (*) denotes a required field.

Facility Information

Enter the business name in the text box.

An asterisk (*) denotes a required field.

Complaint Information

An asterisk (*) denotes a required field.

Review and Submit

Step 1: Complaint Type

Type of Complaint:  

Step 2: Facility Information

Business Name:  
Business Address:  
Business City:  
Business Zip:  
Business Cross Street  

Step 3: Complaint Information

Name:  
Address:  
City:  
State:  
Zip:  
Home Phone:  
Work Phone:  
Email:  
Complaint:
Submitting your complaint...

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