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2. If you have a complaint that needs to be addressed by the Board of Health, please fill out this form or call the office at 508-699-0103. Thank you!

4. Location of Complaint*

   Street address and/or business name of complaint

6. First Name*
7. Last Name*
9. Phone Number*
11. Address*
13. City*
14. State*
15. Zip Code*

17. Please include your information for any follow-up questions, if you are a tenant please include apartment or unit number if you have one

19. Your Email Address*

    Landlord (or Management Co) contact information: name, phone number and email.

21. Description of Complaint*

    Please briefly describe the complaint. Include dates, times and any pertinent information. Include whether you spoke to management / landlord, and the outcome of the discussion.

23. Landlord Information (Housing Complaints)

    Landlord (or Management Co) contact information: name, phone number and email.

Leave This Blank:


25. 1. Receive an email copy of this form.
26. Email address

    This field is not part of the form submission.

27. Submit

* indicates a required field