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.

Contact the Public Health Department

  1. Contact the Public Health Department

    To contact the Public Health Department by email, please complete the online form provided below. We welcome your questions, comments and suggestions. Responses are provided Monday through Friday, 7:30 a.m. to 5:30 p.m.

  2. Please provide a valid email address. All personal information is kept private and used on our end to better assist you.

  3. Information submitted on this form will be sent via unsecured email. To protect sensitive information, do not enter the following items or similar information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, credit card numbers, medical information, passport numbers, and passwords. Please review our privacy policy located at www.jeffco.us/privacy. By submitting this form, you acknowledge and accept the terms listed in the privacy policy.

  4. Leave This Blank:

  5. This field is not part of the form submission.