Report a Public Health Concern

Use this template to contact your state or local health department

Fill in the details below, then copy, email, print, or download your letter.

Template Letter

Fill in your information. The preview updates automatically.

Product Name

Brand (if known)

Store Name

Store Address

Date Observed

Concerns (select all that apply)

Additional Details

Your Name

Your Address

Your Email

Your Phone

For issues affecting the entire state.

For issues in your city or county.

Be specific Include as many details as possible – product names, store address, dates.

Include photos Attach images of the product, packaging, and shelf placement.

Provide location Exact store address helps investigators verify.

Stay respectful & factual Stick to what you observed. Follow up if you don’t hear back.