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Online Complaint Form: Tattoo or Piercing Facility
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. Thank you.
Name of Tattoo/Piercing Facility
Tattoo/Piercing Facility Address
Tattoo/Piercing Facility Address
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
ZIP/Postal Code
Name/Description of Tattoo/Piercing Artist
Date and Time You Observed the Problem
Date and Time You Observed the Problem: Date
Date and Time You Observed the Problem: Time
Description of Problem
Your Name
Your First Name
Your Last Name
Your Telephone Number
Type
- Type -
Home
Office
Cell
Phone
Your Email Address
Leave this field blank