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2. Your Name*
4. Preferred Language*

   This is the language we will use to arrange an interpreter.

6. What day do you plan to visit the Grant County Health District office?*
   What day do you plan to visit the Grant County Health District office?
8. What is the reason for your visit?*

   1. Birth or death certificate
   2. Food permit
   3. Septic or water
   4. Health services
   5. Other
10. Is there anything else you would like us to know?
12. Thank you!

    Our staff have been informed of your visit and look forward to assisting you. Please provide your name at the front desk and they will connect you with an interpreter.

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14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

* indicates a required field