Skip to form

Department of Health City of Stamford

888 Washington Blvd., 8th Floor Stamford, CT 06901


Signature HereClick to Sign
09/30/2023Click to Sign
Signature HereManagers / Supervisors Will Sign Here

Create Your Signature

Please fill in your name and email and then either draw or type your signature below.


Signature Type

Type Draw Upload Custom
Clear Signature

Signature will be applied to the page. You will have a chance to review after signing.

Check this box to continue


Additional Signatures Required