COVID-19 NOTIFICATION FOR CONTRACT TRACING

Thank you for helping us to keep everyone safe by letting us know about your diagnosis or exposure to COVID-19. This form is submitted to one person on our administrative staff responsible for contract tracing and your identity and information provided will remain fully confidential as others are notified of their possible exposure during a Sunday visit.

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • If you know, provide names of the people who were in closest proximity to you on the Sunday you attended before your diagnosis or exposure. This would be especially helpful if you attended a small group meeting on your Sunday visit.
  • This field is for validation purposes and should be left unchanged.