Suspected Food Poisoning


Please fill in details of the suspected food poisoning below.

Fields marked with a * are mandatory.

Complaint / Request Details

If you believe your illness was caused by particular food or a particular food business, please provide details below

Business Address Details

Please provide the address to which the complaint relates or the contact address of the business involved

Your Contact Details

Please provide your details so we can contact you

You must enter at least one of the following methods of contact.

Documents

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.