Epidemiology Data Request Form

Instructions

Please read this form thoroughly prior to submission. Think through your request and fill in all fields as completely and accurately as possible, as this will allow us to fulfill your request more efficiently.

We cannot fulfill requests that extend beyond available resources or compromise confidentiality. Questions and data requests should be emailed to hcsdata@kalcounty.com.

To download and fill out the form by hand, click here.

Contact Information

Person requesting data *

Organization

Email *

Phone Number

Data Request

Date of Request
04/18/2024

Date Needed *

Note: Please allow for a minimum of 14 days to receive your request. Complex data requests may take a longer period of time to complete.

Type of data requested *

include specific groups (age, gender, race, etc), geographic area (county, zip, etc), time frame

Purpose of Data Request (briefly describe below)

Describe Request *

Publish, Present, or Reproduce Data

Grant Proposal

Media (all media requests will be forwarded to the KCHCS Public Information Officer)

Needs Assessment/Planning

School Project/Homework

Other (please describe below)

Describe Other

Health Data Kalamazoo