COVID 19 Screening Test

Please call the office at 519-824-5678 immediately if you answer yes to any of these questions and have an appointment booked within the next 14 days.

If you have been fully vaccinated for over 14 days please answer questions 1 and 2.
If you have not been fully vaccinated or fully vaccinated for less than 14 days please answer questions 1-3.

1. 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

  • If child <18 years of age: nausea/vomiting, diarrhea

2. Have you tested positive for COVID-19 in the past 10 days or been told you should be isolating?

3. Have you had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?