Chicago 311

Submit Licensed Pharmaceutical Representative Complaint Request

Location

Enter street address to search.
Long-click and hold on map pin, then drag to adjust location.

Photo

Description

Name of Licensed Pharmaceutical Representative:

Pharmaceutical company represented, if known:

What are the violations you are reporting? (Select all that apply):

If this is an Ethical Standards Violation; which violation was committed? (Select all that apply):

What time was the violation committed?

What date was the violation committed?

Receive mobile text updates?

Reporter

First name

Last name

Enter an email address to receive a tracking number

Phone

Enter as 999-999-9999

To report pharmaceutical representative's failure to show a license or comply with ethical standards.

Describe the issue you wish to report including a photo and/or a description.
* Indicates a required field.