Residents of Montgomery County may use this portal to report their positive COVID-19 test Once we verify your information, we will email you release dates for you and those that live in your household. Step 1 of 2 50% Confirmation NumberDo you live in Montgomery County(Required) Yes No You cannot go any further with the survey you need to reach out to the health department in the county where you lived. Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY Phone(Required)Email(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Date of Your Positive COVID-19 Test(Required) MM slash DD slash YYYY Location of Where You Tested(Required) Date Your Symptoms Started(Required) MM slash DD slash YYYY Are you a healthcare worker ?(Required) Yes No Do you live or work in a residential facility ?(Required)(such as: a rehab, nursing home, jail, or assisted living) Yes No I am attesting that I am the person or the parent/guardian of the person of who’s information I am now reporting(Required)
