Food Establishment Complaint & Feedback

Complaints/Feedback

You may file a complaint or provide feedback electronically or by mail. To file an electronic complaint or provide feedback please complete the following information and press submit. To file a complaint by mail, please download and print the PDF version of the complaint form and mail the completed form to:

Arkansas Department of Health
Environmental Health
4815 W. Markham, Slot 46
Little Rock, AR 72205-3867

Food Establishment Complaint and Feedback

Complaint/Feedback reported by(Required)

First Last

Are you reporting an illness related to this food complaint?(Required)

Yes

Phone Number(Required)

Email(Required)

Date of Occurrence(Required)

Time of Occurrence(Required)

Name of Establishment(Required)

Number of People Who Dined at the Establishment(Required)

Address of Establishment(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Describe the violation or provide feedback(Required)

Are you willing to be contacted by the health department?(Required)

Yes

If there are multiple people who dined in your group, will you be willing to give their contact information so the health department can reach out to them?

Yes

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Complaints/Feedback

Food Establishment Complaint and Feedback

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