COVID-19 Request Form

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

* indicates required field

Please allow for 5 to 7 business days

Disclaimer

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:  Friday, January 22, 2021 12:09 pm