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COVID-19 Return to Work/School Form

  1. Due to the high volume of COVID-19 cases and calls, the Montgomery County Office of Public Health (OPH) is encouraging residents to complete an online request to expedite the process of obtaining a letter to return to work or school. If you were contacted by a contact tracer, please reach out to them first. Please complete this form and submit it electronically. Upon completion of the online request, OPH staff will contact you to verify the information provided on the form. Please allow 2-3 business days for a reply. If you have questions specific to contact tracing and/or requesting a letter, please email montcocontacttracing@montcopa.org.
  2. This form is for Montgomery County residents only. Residents of other jurisdictions should contact their local health department or PA DOH for assistance.
  3. Complete if RETURN TO WORK
  4. Complete if RETURN TO SCHOOL
  5. Contact Information for Employee/Student Who Needs a Return to Work/School Letter
  6. Complete this section if person above TESTED POSITIVE for COVID-19:
  7. SYMPTOMS
  8. I did not have symptoms.
  9. TESTING
  10. Complete this section if person above was EXPOSED or in CLOSE CONTACT to someone with COVID-19:
  11. Is the person a household member?
    For household contacts, please provide the first day of your household member’s isolation rather than your last date of exposure.
  12. Leave This Blank:

  13. This field is not part of the form submission.