Home Covid Test Reporting
Home Covid Test Reporting
Schoharie County Department of Health
Positive COVID-19 Home Test Reporting Form
Please use this form to report your at-home performed COVID-19 'POSITIVE' test result
SCHOHARIE COUNTY NY residents ONLY
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Enter Information then scroll to bottom of page and click Save
First Name
.......
(mandatory)
Middle Name:
Last Name:
.......
(mandatory)
Date of Birth:
Gender:
Male
Female
Physical Street Address:
Village/Town:
State: NY
................
Zip Code:
One of the following three fields must be have information so we may contact you
Email Address:
Phone #:
.......
(enter as ###-###-####)
(mandatory)
Date of Positive COVID-19 Test
.......
(mandatory)
COVID-19 Test Brand Name/Type:
................
