ADA Complaint/Request Form

The following webform will automatically be forwarded to the County's ADA Coordinator.

Date
The date the complaint was entered
Anonymous complaints are accepted but unless your contact information is included on this form, you will not receive any comments from the Complaint Officer.
Street Address, City State, Zip
Please enter the best contact phone if you wish a return phone call.
Preferred Method of Contact
Explain Other from the above field
The Date, Street Address and City where the Occurrence Took Place
The name of the employee if one was involved and the facility name if it took place in a facility.
This field is expandable so please describe your complaint fully.
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