COVID-19 Pre-Screening

    Please complete this form on the day of your appointment. Read through the questions to determine whether you screen positive or neagtive, and then enter your results and information at the bottom of the page.

    Background question

    1.  Have you received your final (or second) vaccination dose more than 14 days ago?​

    Screening Questions

    ​2. Do you have any of the following symptoms?
    • Fever and/or chills
    • New onset of cough or worsening chronic cough
    • Shortness of breath
    • Decrease or loss of sense of taste or smell
    • If adult >18 years of age: unexplained fatigue, lethargy malaise muscle aches (myalgias)
    ​• If child <18 years of age: nausea/vomiting, diarrhea?
    ​
    ​3. Have you tested positive for COVID-19 in the past 10 days or have you been told you should be isolating? 
    Questions 4 & 5 are to be completed only if you answered "no" to question 1 (background question). 
    ​4. Have you traveled outside of Canada in the past 14 days?
    ​
    ​5. Have you had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?
    ​If response to all of the screening questions is NO: COVID Screen Negative (You can come to your appointment)
    ​If response to any of the screening questions is YES: COVID Screen Positive (Please reschedule)
    ​If you feel unwell please stay home & self-isolate right away. Call Telehealth or your health care provider to find out if you need a test.