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It's a New Day in Public Health.

The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts.

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Online Food and Waterborne Illness Complaint Form

Contact the Florida Department of Health

Please fill out as much of the information listed on this form.  Incomplete forms cannot be appropriately processed.  The fields with (*) asterisks by them are REQUIRED fields. Our system will not process this form without the REQUIRED fields.  Under Florida law, e-mail addresses are public records.  If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity.  Instead, contact this office by phone or in writing.  Please note that this website is not SSL secure and we may not be able to protect your health information from unauthorized access.  If you have concerns about your personal confidentiality, please call us at: FL Department of Health Bureau of Environmental Public Health Medicine Food and Waterborne Disease Program 4052 Bald Cypress Way, Bin #A08 Tallahassee, FL 32399-1712 (850) 245-4299 If you are trying to make a complaint about the cleanliness, employee practices, and/or sanitation of a food establishment, please visit How to Report a Problem with Food in Florida.

Fields marked with an asterisk (*) are required.

SECTION 1:  COMPLAINANT'S CONTACT INFORMATION


SECTION 2:  ESTABLISHMENT INFORMATION (FILING COMPLAINT AGAINST)


SECTION 3: DETAILS OF COMPLAINT


For Product Complaints Only:

SECTION 4:  DETAILS OF ILLNESS


Select all symptoms that apply:




SECTION 5:  CONTACT INFORMATION FOR OTHERS IN GROUP (IF APPLICABLE)