Site Lead Submission · Starter Portal

web

You’re offline. This is a read only version of the page.

CDPH requires that both a Primary and Secondary Point of Contact (Site Leads) be identified for each testing site.

Please use the following form to submit your Site Lead information to CDPH for the Site listed below.

Site

Primary Site Lead

First Name

*

Last Name

*

Email Address

**

Phone Number

*

Secondary Site Lead

Secondary First Name

*

Secondary Last Name

*

Secondary Email Address

**

Secondary Phone Number

*