Form

Brown County Public Health Outreach Request

Would you like to partner with public health?
Brown County Public Health welcomes opportunities to connect with our community.  

Please complete the outreach request survey below to be connected with a member of our staff.  Please complete this form with as much detail as possible so we can connect you with the most helpful resource.

First Name: Last Name: Address: City: State: OtherAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code: Email Address: Phone Number: Comments: What topic or topics would this outreach cover? What type of outreach would you like a member of the Brown County Public Health Staff to assist with? Coalition Presentation Special Event Student Request Other

***IMPORTANT*** Please remember that email should not be considered a secure form of communication; confidentiality cannot be guaranteed. This e-mail address is only checked twice daily and is not for urgent messages. For urgent issues, please contact the Public Health Division using the emergency contact process listed on the homepage.