• Patient COVID-19 Self Scrscreeeening Questionnaire

  • You must answer “NO” to all the questions in this questionnaire in order to enter our physical location. If you answer “YES” to any of the questions, please DO NOT enter the office.

    If you experience any symptoms or answer “YES” to any of these questions, you must immediately contact your health care professional for recommended next steps AND notify our receptionists.

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  • If you answered “Yes” to question one, please DO NOT come into the office. You should:

    • Self- quarantine for at least 14 days from the date on which you first experienced any of the above symptoms ; AND
    • Wait until you have had no fever for at least 3 days (without the use of fever-reducing  medication) AND
    • Improved respiratory symptoms (no cough, shortness of breath)
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  • If you answered “Yes” to any part of question two, please DO NOT come into the office. You should self quarantine for at least 14 days.

    I certify to the best of my knowledge; this information is accurate.

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