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Request for Service/ Complaint Report

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Orange County Health Department Request for Service/ Complaint Report
This Division provides follow-up on requests for service or complaints from the public regarding sanitary conditions, safe water supplies, and inspected establishments in Orange County.  All requests are recorded and treated as priorities. Please complete the following form to report an incident or interaction that needs follow-up. 


*Required field
Name:

Daytime phone to contact you back:

Email* to contact you back:

Property owner or Establishment Name* (be as specific as possible):

Property or Establishment Location* (be as specific as possible):

Date and time of incident/ interaction at Property or Establishment

Complaint Description* (be as specific as possible):