Please fill out this form if you have eaten at a public establishment (e.g. restaurant, wedding, cafe. etc); and had a gastroenteritis symptom such as diarrhea or vomiting.
If you wish to file a complaint regarding the cleanliness of the restaurant or against a specific employee at the restaurant, please use the Food Service Establishment complaint form.
Please complete your three day food history. The three day food history should include your suspected meal and the food you had consumed in the 72 hours prior to that.
Thank you for taking the time to fill out this form. Once you click submit your information will be sent to our epidemiologist.
For further information and understanding of food borne illness or organisms visit this website at the CDC.