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We’re open for appointments! Please review our COVID-19 safety protocols here.

Home » COVID19 Screening Questions

COVID19 Screening Questions

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Please answer the following COVID19 Screening Questions.
Legal Name*
Name you go by (if different than above)
Date of Birth*
Symptoms should not be chronic or related to other known causes or conditions. Fever and/or chills (37.8C/100F or higher), cough or barking cough, shortness of breath, sore throat or difficulty swallowing, decrease or loss of smell or taste, pink eye, runny or stuffy/congested nose
**If you answered YES to ANY of the above questions we will have to reschedule your appointment, for the safety of our staff and other patients.
    Please call or text us at 519 832 5511 or email us to reschedule your appointment.
** COVID19 Policies **
  • If any of the answers to these screening questions change before your appointment, this screening result is no longer valid and you may need to screen again, wherever necessary.
  • Please give us 24 hours notice if you need to reschedule.
  • Any record created as part of screening may only be disclosed as required by law.
Thank you for your understanding!