Isolation Letter Request Form

Isolation Letter Request Form
This intake form should only be completed by residents of Monroe County (Wisconsin) who have tested positive for COVID-19.

Please note that there may be a delay in receiving your letter if we do not yet have a positive lab report for you. Once we can confirm that you tested positive via a lab result, your letter will be sent to you.
Date*

MonthDayYear
Date
Have you had a laboratory test that confirmed you have COVID-19?*

Yes, I have been diagnosed with COVID-19 with a laboratory test (nasal, throat or sputum swab, NOT antibody test). *Home test kits are accepted.No, I have not yet been diagnosed with COVID-19 by a laboratory test
Are You a Monroe County (Wisconsin) Resident?*

YesNo

This form is only for laboratory-confirmed positive cases of COVID-19 living in Monroe County (Wisconsin). If you have questions about an exposure visit http://healthymonroecowi.org/quarantine or being tested visit http://healthymonroecowi.org/covid-19/

If you have been told by a confirmed case that you need to quarantine and need a letter, you can request one here: https://hipaa.jotform.com/202865086399166
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