Before arriving at the clinic post Covid-19 Screening

By law we need to ask you a few questions in relation to Covid-19 just before coming to the clinic.

At the end of the quiz you will be asked for First name &  Last name and email only it will be sent to the clinic and also a copy to you for your records for today. (if you need to go to other placed you can email it to them.   


Pre-Scheduling screening

This provides basic information only and contains recommendations for COVID-19 screening. It is not intended to take the place of medical advice, diagnosis or treatment.

1 / 4

Do you have a confirmed case of COVID-19 or had close contact with a confirmed case of COVID-19?

2 / 4

Do you have any of the following symptoms or signs?

•Fever •New onset of cough •Worsening chronic cough •Shortness of breath •Difficulty breathing •Sore throat •Difficulty swallowing •Decrease or loss of sense of taste or smell •Chills •Headaches •Unexplained fatigue/malaise/muscle aches (myalgias) •Nausea/vomiting, diarrhea, abdominal pain •Pink eye (conjunctivitis) •Runny nose/nasal congestion without other known cause

3 / 4

Have you travelled or had close contact with anyone that has travelled outside of Ontario in the past 14 days?

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Did you wear the required and/or recommended PPE (personal protective equipment) (e.g., goggles, gloves, mask and gown or N95 with aerosol generating medical procedures (AGMPs)) when you had close contact with a suspected or confirmed case of COVID-19?