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get adobe reader*Note: In order to view and print these documents, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe.


Download the Record of Complaint & Results of Investigation

*Note: In order to view and print this form, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe.This form is in a read-only format. Provided you have Adobe Acrobat Reader 4.0 or better, it can be filled out on your computer and printed for mailing. Your work cannot be saved, however.

Instructions for submitting application:

This completed form provides details on the location (restaurant, house, alley, residential area, etc...) and the specific nature of an environmental health complaint.

If you are not sure about something on the application simply call our office and we will be more than happy to assist you.

Submit Application With Appropriate Materials To:

Environmental Health
Richmond City Health District
400 East Cary Street
Richmond, VA 23219


Download the Coordinator's Application for a Temporary Food Permit

*Note: In order to view and print this form, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe. This form is in a read-only format. Provided you have Adobe Acrobat Reader 4.0 or better, it can be filled out on your computer and printed for mailing. Your work cannot be saved, however.

Instructions for submitting application

This form must be filled out by the event sponsor or coordinator listing all food booth participants, and the time and date of special events. Please submit no later than 10 days prior to the event.

If you are not sure about something on the application simply call our office and we will be more than happy to assist you.

Submit Application With Appropriate Materials To:

Environmental Health
Richmond City Health District

400 East Cary Street
Richmond, VA 23219
Fax: (804) 371-2208


Download the Application For Temporary Health Permit

*Note: In order to view and print this form, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe. This form is in a read-only format. Provided you have Adobe Acrobat Reader 4.0 or better, it can be filled out on your computer and printed for mailing. Your work cannot be saved, however.

Instructions for submitting application:

This application is used to request to operate a restaurant, daycare center, adult home, school, or is to be used if ownership is changing at any of the above locations. Applications are usually processed within 5 - 10 days.

If you are not sure about something on the application simply call our office and we will be more than happy to assist you.

Submit Application With Appropriate Materials To:

Environmental Health
Richmond City Health District
400 East Cary Street
Richmond, VA 23219
Fax: (804) 371-2208


Download the Application for a Death Certificate

*Note: In order to view and print this form, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe. This form is in a read-only format. Provided you have Adobe Acrobat Reader 4.0 or better, it can be filled out on your computer and printed for mailing. Your work cannot be saved, however.

Instructions for submitting application

    To request a copy of a death certificate, please submit this application along with $12.00 per copy. Copies may be obtained by an immediate member of the family or designated appointee. Please include a return address and telephone number when applying for a record, and allow 3 days for delivery of your record by mail.

If you are not sure about something on the application simply call our office and we will be more than happy to assist you.

Submit Application With Appropriate Materials To:

    Vital Records
    Richmond City Health District
    400 East Cary Street
    Richmond, VA 23219


Download the Application for a Department of Health Permit

*Note: In order to view and print this form, your computer must have the Adobe Acrobat Reader utility installed; if this software is not installed on your system, you can download it for free from Adobe. This form is in a read-only format. Provided you have Adobe Acrobat Reader 4.0 or better, it can be filled out on your computer and printed for mailing. Your work cannot be saved, however.

Instructions for submitting application

Special event participants who wish to serve food must use this form to list all food and beverages to be served. This application should be submitted 10 days prior to the event. This information must also be submitted to the event coordinator (see coordinator's checklist).

If you are not sure about something on the application simply call our office and we will be more than happy to assist you.

Submit Application With Appropriate Materials To:

    Environmental Health
    Richmond City Health District
    400 East Cary Street
    Richmond, VA 23219
    Fax: (804) 371-2208


Last Updated: 02-29-2012

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