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Vermont COVID-19 Self-Test Result Reporting Form

Name of Person Tested *This question is required.
Please use the format MM/DD/YYYY. This question requires a valid date format of MM/DD/YYYY.
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Home Address and Phone Number of Person Tested
Please enter the name of the test as it appears on the box.
This question requires a valid date format of MM/DD/YYYY.
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Test Result *This question is required.
Your test result is positive. Please visit www.healthvermont.gov/covid19positive for information on immediate steps to take to protect yourself and others.
Your test result is negative. If you are experiencing symptoms and the test you took was an antigen test, it is recommended that you confirm this result with a PCR test. Please visit https://www.healthvermont.gov/testing to find a free COVID-19 test location.
Your test result is inconclusive or invalid. It is recommended to be re-tested.