COVID-19 Questionnaire

Please review the following questions prior to booking an appointment and just before coming for your appointment.

If you answer Yes to any of these questions, please reschedual your appointment for at least 2 weeks or more and see your doctor for an evaluation. Bring a valid doctor's note to your next appointment.

1. Have you travelled outside of Ontario or Canada in the last 14 days?

2. Have you tested positive for COVID-19 or have had close contact with someone who tested positive for COVID-19 without  wearing proper personal protective equipment?

3. Do you have any of the following symptomes: Fever, new onset of cough, shortness of breath, difficulty breathing, sore throat, difficulty swallowing, decrease or loss of sense of smell or taste, chills, headache, unexplained fatigue, muscle aches, nausea, vomiting, diarrhea, abdomina pain, pink eye, runny nose or nasal congestion?

4. If you are 70 years or older, are you experiencing any of the following symptoms: Delirium, unexplained or increase of number of falls, acute functional decline, worsening of chronic condition?



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