Required Screening Questions

1. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.

2. Have you travelled outside of Canada in the past 14 days? Yes No

3. Have you had close contact with a confirmed or probable case of COVID-19? Yes No


or

Name:

Contact # or email:

Upon completion fo the health screening above you will be forwarded to our standard service request form