Health Services

Janet Migliaccio

Health Services

201 E. Coronaca St.
Palestine, TX 75803

Monday - Friday
8:00 am - 5:00 pm

Food Complaint Form

This form may be used to report a complaint about a food service establishment. The Health Inspector will review the complaint and may contact you if any additional information is needed. Any personal information included on this form will be protected and and is not considered public record.

Contact Information

Food Establishment Information

What foods were eaten (include appetizers, entrees, drinks, and desserts)?

Complaint Information

Please describe your complaint about the food service establishment.
Did you or anyone in your party have any illness that you feel is related to your experience with the food service establishment?

What symptoms did you experience?
Date when symptoms appeared
Did you seek medical attention regarding your illness?