Report a COVID Test and Receive an Isolation Affirmation Form
Filling out this form will confidentially report your COVID-19 test results to Sullivan County Public Health. You will also immediately be emailed an Isolation Affirmation Form that you can print out, sign and present as proof that you are isolating or have completed isolation (for example, to your employer or school district).
What Is This Form For?
"Self-attestation" forms are being provided to allow individuals to directly obtain the necessary documentation.
Anyone who needs to provide a school or employer with documented evidence of their illness and isolation period can receive their documentation via this page.
What If I Can't Use This Form?
Anyone who is unable to fill out this form may contact the Sullivan County Public Health COVID Info Line at 845-513-2268 for assistance.
What Should I Do With My Completed Form?
You can provide completed Isolation Affirmations to any appropriate authority that requests them (for example, an employer or a school district). At the very least, make sure to save this form in a secure location online or physically, for future retrieval. You do not need to provide Public Health with a copy.
