• Submit Feedback

    Submit Feedback

  • At TriCounty Health Department, we are committed to continuous quality improvement.

    This form is open to both community members and staff to share positive or negative experiences with our services. You may also use this form to let us know about a public health concern or to request TriCounty Health Department involvement in an issue affecting your community. Responses are anonymous unless you choose to provide your contact information.

  • Which are you:
  • Primary reason for filling out this form:
  • Primary reason for filling out this form:
  • Would you like to provide contact information so that we can follow up?
  • Format: (000) 000-0000.
  • Should be Empty: