COVID 19 SCREENING QUESTIONNAIRE
For Saturday (In-Person) Appointments
Clients are asked to answer the following questions prior to their visit to help everyone stay safe and healthy.
1. Within the past 10 days, have you had any of the following symptoms?
Fever and/or chills
New onset cough or worsening of chronic cough
Shortness of breath or difficulty breathing
decrease or loss of sense of taste or smell
sore throat (painful/difficulty swallowing), runny nose, or nasal congestion
abdominal pain that is persistent or ongoing
conjunctivitis (pink eye)
any headache that is new, persistent, unusual, unexplained or long-lasting
any unexpected extreme tiredness, lethargy, or muscle aches
2. Have you tested positive for COVID-19 in the past 10 days or been told that you should be isolating or in quarantine?
If you responded NO to all questions, you have screened 'negative'.
If you responded YES to any of the screening questions, you have screened 'positive'.
SCREEN POSITIVE AT TIME OF BOOKING?
Please do not attend an in-person appointment until infection symptoms have resolved or 5 days have elapsed since the start of symptoms.
SCREEN POSITIVE ON THE DAY OF OFFICE VISIT?
Please contact the clinic as soon as possible. You will be asked to postpone the in-person visit, and invited to participate in a virtual appointment (via audio- or video-conferencing).