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Investigative Complaint Form

  1. Your Contact Information:

  2. Facility Information:

  3. For foodborne illnesses (getting sick from food that you've eaten), please include: type of food consumed, time of meal, how many people in your party got sick, types of symptoms, time symptoms started, how long symptoms lasted, if you went to a doctor, etc.

  4. Leave This Blank:

  5. This field is not part of the form submission.