• To be completed ON THE DAY OF YOUR APPOINTMENT only

    Please only complete the Ontario Ministry of Health Patient 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.
  • MM slash DD slash YYYY
  • In the last 10 days I have not experienced COVID-19 symptoms, travelled outside of Canada, tested positive for COVID-19 or been in close contact with a confirmed or suspected case of COVID-19

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