COVID-19 Request Form

i am requesting a letter for: (check as applicable)

* indicates required field

Please allow for 5 to 7 business days


These forms are not Medical release forms and they do not exempt you from your work place protocols which may differ from the CDC and MDPH guidance. The Department of Health and Human Services recommends that individuals check with their Health Care Provider (Primary Health Care Provider, Doctor, and NP) before returning to Public Activities.

Page last updated:  Thursday, November 10, 2022 11:27 am