COVID screening

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COVID-19 Assessment

* Indicates required field

Name *

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 *

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 *

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 *

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 *

Submit

About
Services
Resources
- Store
- Podcasts
- Blog
- Free resources
Store
- Digital Downloads
- Gift Certificates
Book Now