COVID-19 Screening

Your Name (required)

Your Email (required)

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.
Fever or ChillsNoYes
Difficulty breathing or shortness of breath NoYes
Cough NoYes
Sore throat, trouble swallowing NoYes
Runny nose/stuffy nose or nasal congestion NoYes
Decrease or loss of smell or taste NoYes
Nausea, vomiting, diarrhea, abdominal pain NoYes
Not feeling well, extreme tiredness, sore muscles NoYes

2. Have you had close contact with a confirmed or probable case of COVID-19?
NoYes

3. Have you traveled outside of Canada in the past 14 days?
NoYes

4. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?
NoYes