Please fill in details of the suspected food poisoning below.Fields marked with a * are mandatory.
If you believe your illness was caused by particular food or a particular food business, please provide details below
Please provide the address to which the complaint relates or the contact address of the business involved
Please provide your details so we can contact you
You must enter at least one of the following methods of contact.
You may upload documents related to this request.File types accepted are (image files/.txt/.doc/.docx/.pdf/.rtf) Total file size must not exceed 5Mb.
Files: Maximum 5
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