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:

“Parking-lot waiting room”: If you are driving, 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.
Please wear a mask if you have one.

* 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