COVID-19 Request Form Today's dateName *Date of birth *SexMaleFemaleMailing address *City *State *Zip code *Home or cellphone *i am requesting a letter for: (check as applicable)Reason(s) *Return to work letter after IsolationReturn to work letter after QuarantineOrder to stay home (Isolation)Order to stay home (Quarantine)Day careComments* indicates required fieldPlease allow for 5 to 7 business daysDisclaimerThese 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. Submit