Positive COVID-19 Home Test Reporting Form

Please use the form below to report a POSITIVE result from a FDA-approved COVID-19 home test.  Please DO NOT use this form to report results of testing completed through your doctor’s office, urgent care, hospital, community clinic, pharmacy, on-site at school, or any other work-place testing program.

A photo image of your positive test result is REQUIRED. Please DO NOT submit this form if your test was more than 5 days ago.