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General Inquiries
This is a general contact form for DeKalb Public Health. Any inquiries sent to us via this form will be directed to the appropriate team member for response based on the information provided. Please allow up to 5 business days for a response.
Your Information
Full Name
First Name
Last Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Where did you receive service?
*
Please Select
Clifton Springs Health Center
East DeKalb Health Center
North DeKalb Health Center
Richardson Health Center
T.O. Vinson Health Center
Mobile Outreach Event
Your Home
Your Business
Other
Prefer not to say
Not applicable
Other location:
What type of service did you receive?
*
Please Select
Clinical Service (Immunization, Family Planning, Medical Records, Travel Medicine, TB, Pregnancy Testing, HIV/STI, PREP/PEP, Health Check, Sports Physical)
Health Assessment and Promotion (Diabetes Prevention, Injury Prevention, Tobacco Use Prevention & Cessation)
Maternal & Child Health (Babies Can't Wait, Children 1st, Children's Medical Services, Early Hearing Detection & Intervention, MORE, WIC, Adolescent Health & Youth Development)
Vital Records (Birth Certificates & Death Certificates)
Environmental Health -Body Art, Hospitality, Lead Poisoning, Mosquito Control, Rodent Control & Septic Systems
Environmental Health -Food Safety
Environmental Health -Public Pools, Beaches & Spas
Oral Health
Other
Prefer not to say
Not applicable
Other service:
Inquiry Details
How can we help you?
*
What resolution are you seeking?
Supporting Documents (Optional)
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Type of Inquiry
Please Select
1) Business Hours
2) Appointment
3) Complaint
4) Partnership/ Participation
5) Open question
6) Volunteer
7) Other
Alyson comments -Resolution:
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