1. Have you had close contact with anyone with acute respiratory Illness or travelled outside of Ontario in the past 14 days?

2. Do you have a confirmed case of COVID-19 or had close contact with a confirmed case of COVID-19?

3. Do you have any of the following symptoms:

• Fever (temperature of 37.8 °C or higher)

• New onset of cough

• Worsening chronic cough

• Shortness of breath

• Difficulty breathing

• Sore throat

• Difficulty swallowing

• Decrease or loss of sense of taste or smell

• Chills

• Headaches

• Unexplained fatigue/malaise/muscle aches 

• Nausea/vomiting, diarrhea, abdominal pain

• Pink eye (conjunctivitis)

• Runny nose/nasal congestion without other known cause

Thank you for your response. Please note that if you responded 'yes' to any of the above questions, we ask that you please contact us to reschedule your appointment.