Online Complaint Form: Restaurants & Bars

Instructions: Please enter as much information as possible. Items with * are required fields. Any information you provide is confidential. You may choose to remain anonymous however please enter a valid e-mail address and telephone number in case we need to contact you for additional information. When you are finished click the "Submit" button. If you prefer, you may file a complaint by phone at (716) 961-6800.

To report a food related illness, please call (716) 961-6800. Do not use this form.

Thank you.

Business Name

Business Address

City/Town

State/Province

ZIP/Postal Code

Date You Observed the Problem

Time You Observed the Problem

Did you speak to anyone at the facility about the problem?

If yes, who did you speak with?

Description of Problem (150 words or less)

Your First Name

Your Last Name

Your Phone Number

Your Email Address