Clone of Lodging Complaints

Taney County Health Department
Pool/Spa Concerns
Establishment Name (Missouri establishments only):*
Establishment Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date you visited the establishment*

MonthDayYear
Date
Nature of Complaint/Concern:*
Do you want to remain anonymous?*

YesNo
If you select Yes, you will remain publicly anonymous, however we still need you to provide contact information incase our investigators have additional questions.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
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