The Cancer Registry of Greater California is a Program of the Public Health Institute

Initial Request Form for

Confidential Cancer Registry Data

Thank you for your interest in obtaining data from the Cancer Registry of Greater California (CRGC). Please provide the following information about the project that prompts your interest in cancer registry data, and CRGC research staff will contact you within 5 business days to discuss your request. If you have any questions, please email:


Contact Information

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Basic Information

Use exact wording from grant proposal or IRB, if possible. Type or attach abstract.


Check any/all that may apply, leave blank if not applicable