COVID19

Pre-Appointment COVID-19 Screening and Arrival Instructions

You must complete and submit this questionnaire BEFORE your appointment; note that we will ask these same questions at the start of your appointment.

Only essential people (e.g translator, advocate) may also attend the appointment with you; they must also complete the screening questions separately.

Arrival Instructions:

Wait in your car until your appointment time.
Arrive as close to your appointment time as possible; we have limited seating and must manage the flow of people coming and going. But, we can always accommodate people with disabilities and those needing extra time or assistance.
You are required to wear a mask on arrival.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Are you experiencing cold, flu or COVID-19-like symptoms, even mild ones? Symptoms include: fever, chills, cough, shortness of breath, sore throat and painful swallowing, stuffy or runny nose, loss of sense of smell, headache, muscle aches, fatigue or loss of appetite. *

Have you travelled to any countries outside Canada, including the USA, within the last 14 days? *

Did you provide care or have close contact with a person with confirmed COVID-19? Note: This means you would have been contacted by your health authority’s public health team. *

Submit