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Lewis & Clark Public Health

publichealth@lccountymt.gov

1930 9th Avenue Helena, MT 59601

406-457-8900

Covid-19 At-Home Test Self-Reporting

Please complete this form if you have used an At-Home Covid-19 Test Kit and would like to report your results to Lewis and Clark Public Health.

Full Name

Date of Birth

Sex at Birth

Date of Positive Test

Date Picker

Were you experiencing symptoms at the time of testing?