Action Center / Health Department Service Request / Whitley County, Indiana

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Health Department Service Request

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If you'd like to request service from the Environmental Health Division of Whitley County complete the information below.

* Denotes a required field

First Name*

Last Name*

Address

City

State

ZIP Code

Zip-Zip +4
Second portion of ZIP Code is optional.

Explain in as much detail as possible the reason for your request for the Environmental Health Division's help.

I'm requesting help from the Environmental Health Division because:*

Date You Are Providing This Request*

MonthDay Year,

Please Do Not Complete The Following Field