Form Center

2. Use the form below to contact the Frederick County Health Department. Please be advised that we cannot send confidential information through email. To speak to someone immediately, please call our main number 301-600-1029. Our regular business hours are Monday - Friday, 8:00 a.m. - 5:00 p.m. You may call Central Alarm at 301-600-0311 for urgent after hour calls.
   
   The Frederick County Health Department cannot guarantee the security of correspondence sent electronically over the Internet. Due to the volume of e-mail and Internet traffic coming in and out of the Frederick County Health Department, e-mail may take up to twenty-four hours during regular business hours (or longer if form is submitted on a weekend or holiday) to be delivered to the recipient.
   
   Please do not ask us to promote products or services. The Health Department only posts materials and resources generated by governmental entities, educational institutions, or nationally recognized organizations.
4. First name:*
5. Last name:*
7. Phone number (XXX-XXX-XXXX):
8. Email address:
10. Preferred contact method:

    1. Phone
    2. Email
11. Choose a service:*
    -- Select One --Accreditation (PHAB)Adult Evaluation & Review Services (AERS)AudiologyBilling InquiryBirth certificate Burn permitCancer and Chronic Disease PreventionCare of sick and injured students in public schoolsChildren’s Dental ClinicCORECOVID vaccination card replacementCOVID questionData/ReportsDeath certificateDiabetes/Prediabetes - InformationEnvironmental Health ServicesFood Permits or ComplaintsHealth OfficerHealth Professionals InformationHearing and Vision Screening in public and private schoolsHepatitis C TestingHigh Blood Pressure (Healthy Heart program)HIV Testing & CareHome birth certificate informationHuman ResourcesImmunization ClinicInfants & Toddlers ProgramInternships/Volunteer OpportunitiesLead and Asthma Home VisitingMaryland Children's Health Program (MCHP)Media RequestsMedicaid Administrative Coordination of Care Unit (ACCU)Medicaid OmbudsmanMedicaid TransportationMedical Assistance/ Medicaid/Health InsuranceMedical Records RequestMedication and treatment administration to students at public schoolMental HealthNavigator Overdose Response TrainingPayment/Payment InquiryPeer RecoveryPregnancy and infant loss bereavement navigationPublic Health PreparednessPublic Information Act RequestsPublic Pool InspectionsRabies (human exposure)Records/Public Information Act RequestsRecovery Coach AcademySafe Kids Car Seat ProgramSchool-based Services Program (Occupational & Physical Therapy)Smoking CessationSpecial Delivery Mother Baby Nurse Home VisitingSubstance Use Recovery SupportStreet Safe ProgramTuberculosis treatment Well & Septic PermitWebsiteWIC (Women, Infants, & Children)Other
13. Brief Description*
Leave This Blank:


15. Submit

* indicates a required field