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Vermont COVID-19 Self-Test Result Reporting Form

Use this form to report results from taking an at home COVID-19 test, also known as an over the counter test or self test. Your response is confidential, and reporting your test result helps the Health Department understand how many Vermonters are being tested for COVID-19 and how the virus is spreading in our communities. If your test result is positive, the Health Department will use the information you provide for contact tracing. The Health Department will not contact you if your test result is negative.
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.
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.
Test Result *This question is required.
Your test result is positive. Please visit 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 to find a free COVID-19 test location.
Your test result is inconclusive or invalid. It is recommended to be re-tested.