Illness Self-Report Form
Please complete the following form.

Once received you will be contacted by a member of the Student Life Team or the Office of Human Resources to answer questions you may have about resources available to you during your illness.

If it is after business hours AND you are an on-campus student, please contact the Emergency On-Call Residence Life Staff at 406.698.8777.

When a student or employee of RMC completes the Illness Report Form and contacts Riverstone Health or another local healthcare provider, it is important to ask the following questions regarding your care so that you may return to normal day to day activities at RMC as quickly as possible.

1. Should I be tested for COVID-19? If so, where may I be tested and when?
2. If I am tested, when should I expect to receive my results and how do I obtain them?
3. Should I isolate myself from others? If so, for what length of time?
4. How do I obtain documentation regarding my ability to return to work or school from your healthcare facility?
5. Please explain to me the steps involved in this process, so that I know what to expect as I work to return to normal activities.
Email address *
First and Last Name *
Cell Phone Number *
Status *
If Campus Visitor or Other please explain
RMC Athletic Program *
Major *
I am *
Tested for COVID-19 *
If tested - what date
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DD
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YYYY
Other information:
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