• To be completed ON THE DAY OF YOUR APPOINTMENT only

    Please only complete your COVID-19 screening ON THE DAY OF YOUR APPOINTMENT. Unfortunately, we are unable to accept screening questionnaires completed the evening before your appointment. We are sorry for the inconvenience.
  • Date Format: MM slash DD slash YYYY
  • I DO NOT have any COVID-19 symptoms or risk factors

    If you (or members of your household) do not have any COVID-19 symptoms or risk factors please confirm this by checking the negative screening statement below.