Burlington County Health Department Complaint Form

Burlington County Health Department Complaint Form

All complaints will be investigated within 48 hours of receipt.

All fields marked with an asterisk(*) must be filled out in order for the complaint to be investigated.

Note: Mosquito complaints should be entered using the Mosquito Complaint form.

Stagnant pool complaints can be entered into the form below.

Your Information

Entry Id

Name of Person Submitting Complaint:*

First Name

Last Name

Your Street Address:

Your Town:

Your Phone Number:*

Your Email:*

The Preferred method if you would like to be contacted:

Phone Email

Complaint Information

Street Address (where complaint exists):*

Town:*

Name of business (if applicable):

Nature of Complaint (please be specific):*

Homeowner Association or Landlord Name and phone number (if applicable):

Date Created

Created By

Last Updated

Updated By