Covid 19 Screening Form

ONLY COMPLETE WITHIN 24HRS OF SESSION

I am taking this screening as:
Please select the applicable age group below:
Do you have any of the following symptoms? Check all that apply:
Have you or anyone in your household travelled outside of Canada in the past 14 days?
Have you had close contact with a confirmed or probable case of COVID-19
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?
In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? If you already went for a test and got a negative result, select “No.”
Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?

Thanks for submitting!