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Update Your Contact Information to Receive Health Alerts

The Alameda County Health Care Services Agency (HCSA) is updating our contact lists to ensure important messages about COVID-19 and other public health concerns reach our provider partners. Please take a few minutes to enter your information into this survey.

For more information about HCSA Health Alerts, please email HCSAContacts@acgov.org.

Name

First
Last

Suffix

Please enter an 'other' value for this selection.

Credentials (including degrees)

Job Title

Organization/Facility

E-mail address

Primary e-mail
Secondary e-mail

Website (URL)

Address

Number and Street
Apartment/Suite/Unit

City

Other Zip Code

Phone Numbers

Cell Phone
Other Phone
Other Phone Extension
Fax Number
Pager

Would you like to add a secondary location for yourself?

Secondary Location

Name of Secondary Location
Street Address
Apartment/Suite/Unit
City
Zip Code

What is your primary affiliation?

Which type of clinic?

Community-Based Clinics and/or Federally Qualified Health Centers (FQHCs)

Dialysis Clinics

Which type of hospital or subacute?

Comprehensive Outpatient Rehabilitation Facilities (CORFs)
Emergency Rooms
Infection Control for hospitals
Psychiatric Residential Treatment Facilities (PRTFs)

Religious Nonmedical Health Care Institutions (RNHCIs)
Surgical Centers
Transplant Centers

Which type of Long-Term Care Facility?

Which type of healthcare provider?

Dental
Health Care Administrator
Infectious Disease

Internal Medicine
Pediatrics

Which type of laboratory?

Hospital
Public Health
Other - Write In Please enter an 'other' value for this selection.

Which type of city, county, regional or state affiliation?

County managers and other city staff
County park districts
Regional elected officials and staff
State of California Department of Public Health Services (CDPH)
State of California elected officials and staff

Which type of other health?

Pharmaceutical Reps
Public Health
Vector Control
Veterinarians

Which type of CBO/ community partner?

Which type of first responder?

City and County Emergency Operations Center/Department Operations Center (EOC/ DOC)
Disaster Planners
Fire

Public Information Officers (PIO)
Safety Officers

What is your educational affiliation or role?

Childcare Providers & Licensing
School Board Members
School Nurses

Schools, Colleges, Universities
Superintendents

Do you serve in any of these roles in your agency or organization?

Emergency Preparedness Coordinator
Infection Control Officer or Coordinator

Are you a member of the Disaster Preparedness Health Coalition (DPHC)?