Form Center Module

Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

▼Public Use Forms

  1. 2022 Community Health Needs Assessment (CHNA) and 2020-2022 Community Health Improvement Plan (CHIP) Feedback Form

    Complete this form to provide feedback for the 2022 Community Health Needs Assessment (CHNA) and the 2020-2022 Community Health... More…

  2. Foodborne & Waterborne Illness Investigation Questionnaire

    Individuals are required to provide information about their illness and eating/drinking habits as part of a foodborne illness... More…

  3. Request a Health Presentation

    Complete this form to request a health presentation at your organization.

  4. Smoke-Free Housing Directory Registry

    Complete this form to list your smoke-free property in the Smoke-Free Housing Directory.

  1. Contact Us

    Let us know if you have a question, comment, or request.

  2. Public Health Complaint Form
  3. Request Us at Your Health Fair or Community Event

    Complete this form to request us at your health fair or community event.

  4. Submit a Smoking Complaint

    Complete this form to report a suspected Smoke-Free Illinois Act violation observed in McLean County.