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About
Sarah Knight PhD
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COVID-19 Assessment
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Name
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First
Last
Email
*
Date of appointment
*
Are you currently experiencing any of these symptoms?
(choose any new, worsening, and not related to other known causes or conditions)
Choose Any
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Fever
Chills
Cough that is new or worsening
Barking cough, making a whistling noise when breathing
Shortness of breath
Sore throat
Difficulty swallowing
Runny, stuffy or congested
Decrease or loss of smell or taste
Pink eye
Headache that’s unusual or long lasting
Digestive issues like nausea/vomiting, diarrhea, stomach pain
Muscle aches that are unusual or long lasting
Extreme fatigue that is unusual
Falling down often
None of the above
In the last 14 days, have you been in close physical contact with someone who currently has COVID-19?
(being less than 2 metres away in the same room, workspace, or area; living in the same home; being in the same classroom)
Select one
*
Yes
No
In the last 14 days, have you been in close physical contact with someone who either:
• is currently sick with a new cough, fever, difficulty breathing, or other symptoms associated with COVID-19?
• OR returned from outside of Canada in the last 2 weeks?
Select One
*
Yes
No
Have you travelled outside of Canada in the last 14 days?
(This does not include essential workers who cross the Canada-US border regularly.)
Select One
*
Yes
No
Submit
About
Sarah Knight PhD
Why hum?
Booking, Fees & Policies
Offerings
Workshops + Training
Classes + Gatherings
>
DeStress and ReCharge
Yoga Nidra
Improv for Humans
Field to Form
Healing Sessions
Podcasts
Blog
Free resources
Contact
Book Now