COVID-19: Anonymous Report of Positive Antigen Test

Call the COVID Line at 907-772-5788 for clinical guidance.

Treatment options are most helpful when given early in the course of your illness. If your test is positive, isolate from others and notify your close contacts.

If you have symptoms and test negative, retest again 24-48 hours later. Call the COVID information line if you have any questions about your test or symptoms.

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* 1. Date of positive Test

Date / Time

Date

Question Title

* 2. When did your symptoms begin?

Date / Time

Date

Question Title

* 3. How ill are you?

OK, no symptoms

A few symptoms, nothing that keeps me from doing my normal activities

I have some symptoms that can be managed with rest, fluids and tylenol

I'm really ill, no energy, hard to stay awake or other symptoms that make me very uncomfortable

I'm having severe symptoms, hard to breath, short of breath, high fever

Other (please specify)

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* 4. What is your Age?

9 or younger

10-19

20-29

30-39

40-49

50-59

60-69

70 or older

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* 5. What is your vaccination status?

Vaccinated and booster received

Received one or more vaccines and no booster

No vaccine

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* 6. Are you currently in Petersburg?

Yes

Petersburg resident, currently out of town