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Self-Attestation Portal

Report a COVID Test and Receive an Isolation Affirmation Form

Filling out this form will confidentially report your COVID-19 test results to Sullivan County Public Health. You will also immediately be emailed an Isolation Affirmation Form that you can print out, sign and present as proof that you are isolating or have completed isolation (for example, to your employer or school district).

NOTE: If you are seeking a Quarantine Affirmation Form or you have further questions, please scroll farther down the page.

Create a Quarantine Affirmation Form

If you or your child quarantined (this means you or your child were exposed to someone who tested positive for COVID-19), please click here to fill out THIS DOCUMENT. It is a fillable PDF - just click in the area you wish to complete, then begin typing. If you have trouble typing in the PDF, print it out and complete in blue or black pen.

If you or your child isolated (this means you or your child tested positive for COVID-19), please scroll back up the page and fill out the Isolation Affirmation Form.

What Are These Forms For?

"Self-attestation" forms are being provided to allow individuals to directly obtain the necessary documentation.

Anyone who needs to provide a school or employer with documented evidence of their illness and isolation period will be able to submit their test results to Public Health and receive their documentation via this page.

What If I Can't Use These Forms?

Anyone who is unable to fill out these forms or submit their test results electronically may contact the Sullivan County Public Health COVID Info Line at 845-513-2268 for assistance.

What Should I Do With My Completed Forms?

You can provide completed Isolation or Quarantine Affirmations to any appropriate authority that requests them (for example, an employer or a school district). At the very least, make sure to save these forms in a secure location online or physically, for future retrieval. You do not need to provide Public Health with a copy.