MANDATORY COVID-19 PRE-SCREENING FORM

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:
You must check and agree to all of the following prior to being approved for an appointment:
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?
By submitting this form, you confirm that you have answered truthfully and agree to the above terms

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