E-Gov Services City of Harlingen

Complainant's information will remain confidential and used for contact purposes only by the Health Department. Any suspect food-borne illnesses should be reported immediately to the Health Department at 956.216.5220.

RESTAURANT COMPLAINTS

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Purpose. This form is used to report any unsanitary conditions noted by a restaurant patron.

* Information is required.

Contact Information

First Name:
Last Name:
* Business Name:
Email:
Daytime Phone:	() –
Fax:	() –
* Address:
City:
State:
ZIP:

Issue/Problem Location:

* Address	- Or Other Not Listed - Invalid Address The address you entered does not match any in the system. You can select a valid address from the list, or if you are certain the address you entered is correct click the "Use the address I entered" button, to continue. The address you entered
Unit:
	Provide any additional information on problem location in the box below.

* Nature of the complaint/suggestion...

* What is the name and address of the restaurant?

* Date and time of incident

Attach a Picture or File (max size: 30MB):

Add Another FIle

Click the map where the issue is located. Drag the map point if it needs to be moved.

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* Information is required.

Notes:

If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.