Form Center

2. Complete this form to file a non-emergency public health complaint or ask a question to the Whatcom County Health and Community Services.

   If this is an emergency, please call 911. Do not use this form for emergencies.

   Bats/Rabies Notice: Do not complete this form if a bat has bitten you or if you suspect rabies exposure. Instead, immediately call us at (360) 778-6000 and/or contact your primary care provider.

   We review submissions Monday-Friday, 8am-4pm except on legal holidays. Depending on the complexity of your question, it may take us three to five business days to respond to you.

   Disclaimer: Information submitted on this form will be sent via email. To protect sensitive information, do not provide the following information in your submission: Social Security number, driver’s license number, bank account information, routing numbers, medical information, passport numbers or passwords.

4. 1. I am completing this form to...*

   1. Ask a question.
   2. File a complaint.
6. 2. Choose a category that best fits your question or concern.*
   -- Select One --Complaint – Drinking WaterComplaint – Algae BloomComplaint – BatsComplaint – Garbage/Illegal DumpingComplaint – Illegal Installation of Sewage SystemComplaint – Illness from FoodComplaint – Unsanitary Food EstablishmentComplaint – Unpermitted Food EstablishmentComplaint – Improper Solid Waste ManagementComplaint – Indoor / Outdoor SmokingComplaint – Lead ExposureComplaint – Mosquito/BugsComplaint – Pet Waste on GroundComplaint – Public PoolsComplaint – RatsComplaint – RV ParksComplaint – SchoolsComplaint – Sewage on the GroundComplaint – Sewage System FailingComplaint – Site Hazard/Potential Site Contamination (Includes Illegal Drugs)Complaint – Unsure/OtherQuestion – Algae BloomQuestion – Bats / Rodents / Other PestsQuestion – Birth / Death CertificatesQuestion – Food Establishment RegulationsQuestion – Food SafetyQuestion – Hazardous WasteQuestion – Improper Solid Waste ManagementQuestion – Inspections / Inspection ResultsQuestion – Lead Exposure Question – MoldQuestion – Public Pool / Spa RegulationsQuestion – Rivers / Lakes / BeachesQuestion – SchoolsQuestion – Unsure/Other

   Bats/Rabies Notice: Do not complete this form if a bat has bitten you or if you suspect rabies exposure. Instead, immediately call us at (360) 778-6000 and/or contact your primary care provider.

8. 2b. Do you want to opt in to confidentiality for public records?

   Submissions of this form are public records that, upon request, may be subject to release. Pursuant to RCW 42.56.240(2), you may request that your name and contact information be kept confidential if a public records request is made. You may also submit this form anonymously. Please note, anonymous submissions may limit our ability to respond to a complaint if we need more information.

   1. Yes, I want to opt in and keep my contact information confidential.
   2. No, I do not want to opt in to confidentiality.
10. 3. Tell us about your question or concern. Please be as detailed as possible.*
12. 3b. Upload a Photo (Not Required).
14. 4. Restaurant Name.*
16. 5a. Restaurant Address*
17. 5b. City.*
19. 6. Date Visited
    6. Date Visited
21. 6. Number of persons in group (including yourself).*
23. 7. Number of ill persons in group (including yourself).*
25. 8. Suspected Food.*
27. 9. Consumption Date*
    9. Consumption Date
29. 10. Illness Start Date*
    10. Illness Start Date
31. 4a. Address/Location of Issue.*
32. 4b. City.*
34. 5a. Do you need to specify a location at the address above? (e.g., front yard, behind barn, etc.)*
    -- Select One --YesNo
36. 5b. Specify location of issue at specified address.*
40. Contact Information
42. First Name
43. Last Name
45. Phone Number
46. Email
48. Address Line 1
50. Address Line 2
52. City
53. State
54. Zip
56. How would you like to be contacted regarding your question or concern?

    Please note, some situations may not require follow up.

    1. Email
    2. Phone
Leave This Blank:


57. 1. Receive an email copy of this form.
58. Email address

    This field is not part of the form submission.

59. Submit Submit and Print

* indicates a required field