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.

Type of Complaint:*


Facility Information

Enter the name of the business name in the text box.

Select matching facility from list below

Cannot find the facility
Business Address:

Business City:*
 
Business Zip:
 
Cross Street:
 

Complaint Information

Your Name:
 
Your Address:
 
City:
 
State:
 
Zip:
 
Home Phone:
 
Work Phone
 
Email:*
 
Description of Incident:*

Review and Submit

Type of Complaint
Facility Information
Business Name:
Business Address:
Business City:
Business Zip:
Business Cross Street
Complaint Information
Name:  
Address:  
City:  
State:  
Zip:  
Home Phone:  
Work Phone:  
Email:  
Complaint:
Submitting your complaint...