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Request Your Official Isolation Form After a Lab Confirmed Positive Test Result
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First name:
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Your answer
Last name:
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Your answer
Date of birth:
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MM
/
DD
/
YYYY
Phone number:
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Your answer
Email address to which you would like the letter sent:
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Your answer
Physical address:
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Your answer
Date of your COVID-19 test:
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MM
/
DD
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YYYY
Have you had or are you current exhibiting COVID-19 symptoms (coughing, shortness of breath, fever, loss of taste or smell, etc.)?
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Yes
No
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