Restaurant Complaint Form Tweets by Racine Health Home >Departments>Health>Environmental Health Environmental Health Restaurant Complaint Submission Form: Restaurant Complaint Submission Form "*" indicates required fields Disclosure: Contact information is always confidential and never disclosed to the establishment. It is only used for our sanitarians to contact you to gather additional information. Contact Name First Last Phone NumberEmail address Would you like to be contacted? Yes No Establishment details (Required) Establishment Name*Establishment Address*Date of Incident* MM slash DD slash YYYY Time of Incident* Hours : Minutes AM PM AM/PM ComplaintDid you notify the establishment about your complaint? Yes No Who did you speak with?ResponseCall (262) 636-9203 for further assistanceClick "Submit" once Any information you provide on this form may be subject to disclosure under Wisconsin’s Public Records laws, in accordance with Wis. Stats. §§ 19.31-19.39.