Complaint Form

Your input and concerns are important to the Polk County Health Department. Please complete and submit the form below if  you experienced unsafe food-handling practices or unhealthy conditions.

However, if you are filing a complaint because you or a member of your party became ill after eating and/or drinking at a food establishment, we need to speak with you. Please call 715-485-8532 Monday - Friday, 8:30 a.m. - 4:30 p.m. for a brief and confidential interview.  If you consider this an emergency, please dial 911 or your regular doctor.  If a situation occurs after-hours and you feel we should know about it, please contact the Non-Emergency Dispatch Line at 715-483-8300.

Edit Form

Name:*

E-mail address:*

Telephone:*

Establishment Name:*

Establishment City:*

Date of Visit*

Approximate time of your visit:*

Observation that prompted you to file this complaint:*

<a href="http://www.polkcountywi.gov/polkcountyhealth/restaurants_vending_temporary_restaurants/complaint_form.php">Your Link Name</a>