UCLA Community Screening Additional Contacts
Please fill out this form to add new contacts to the Community Screening Program for COVID-19 Testing (or to remove prior contacts select the last option)
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Contact First Name *
Contact Last Name *
Contact UID (nine digit university ID number) *
Email *
Contact should be tested twice weekly because  (check all that apply)
Contact should be tested every two weeks (every 12-16 days), because  (check all that apply)
Contact should be tested voluntarily (encouraged to test regularly) because (check all that apply)
Contact should be removed from the Community Screening Program because...
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