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Request for Notice of Quarantine/Isolation Letter

  1. Name
    Please fill out your first and last name.
  2. What is your date of birth?
  3. Please provide a phone number in case we need to contact you.
  4. Please list your place of employment.
  5. Name of person you were exposed to
    Please give the name of the person with COVID-19 you were exposed to, unless you are the positive case then put "N/A" in each field.
  6. If you are a close contact, please select the last date you were in contact with the COVID-19 positive person. If you have tested positive, please select the date you became symptomatic or the date you were tested if you were tested without symptoms.
  7. Please include the email address you would like your letter to be sent to.
  8. Address for mailed letter
    Please fill out your address below if you would like the letter mailed to your residence.
  9. Leave This Blank:

  10. This field is not part of the form submission.