Pre-screening Questionnaire
Have you travelled outside of Canada in the past 14 days?
Have you tested positive for COVID-19 or had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?
Are you experiencing or have you experienced any of the following in the past 14 days:
If 70 years of age or older, are you experiencing any of the following symptoms: delirium, unexplained or increased number of falls, acute functional decline, or worsening of chronic conditions?
You must check and agree to all of the following prior to being approved for an appointment:
By submitting this form, you confirm that you have answered truthfully and agree to the above terms

After you've submitted this form, you'll be re-directed to the bookings page where you'll be able to book your appointment.

If for any reason, your answers warrant further screening, we will be in touch.

Otherwise, we will ask you to answer the questionnaire again prior to the start of your appointment.

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6-4891 Dundas St. W., Etobicoke, ON M9A 1B2 T: 647.922.0498  E-mail:

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