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Covid-19 Pre-Screening for Clinic Visit

Do you have one or more of the following symptom(s) without known cause?
  • Fever and/or Chills - Temperature 37.8 degree Celsius or higher

  • Cough or worsening chronic cough

  • Shortness of breath

  • Decease sense or loss of smell or taste

  • Sore throat

  • Difficulty swallowing

  • Headache, unusual or long lasting

  • Unexplained fatigue, muscle aches/joint pain

  • Digestive issue like nausea/vomiting, diarrhea

Have you been tested positive for COVID-19 or had closed contact to a confirmed or suspected case of COVID-19?
Have you travelled outside of Canada in the last 14 days?
Have you vaccinated against COVID-19?
If Yes, how many doses?

You have successfully submitted the form.

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