Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Environmental Health Complaint Referral Form

  1. letterhead top bar.bmp

  2. Tell us about yourself:

    Chautauqua County Health Department will not disclose your name and contact information, but this information is required to submit a complaint. Incomplete or fictitious submissions will not be investigated.

  3. Tell us about your complaint:

  4. 500 character limit

  5. 3/2014

  6. Leave This Blank:

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