- Have you had close contact with anyone with acute respiratory illness or travelled outside of Ontario in the past 14 days?
- Do you have a confirmed case of COVID-19 or had close contact with a confirmed case of COVID-19?
- Do you have any of the following symptoms:
- New onset of cough
- Worsening chronic cough
- Shortness of breath
- Sore throat
- Difficulty swallowing
- Decrease or loss of sense of tatse or smell
- Unexplained fatigue/malaise/muscle aches (myalgias)
- Nausea/vomiting, diarrhea, abdominal pain
- Pink eye (conjunctivitis)
- Runny nose/nasal congestion without other known cause
- Are you 70 years of age or older, experiencing any of the following symptoms: delirium, unexplained or increased number of falls, acute functional decline, or worsening of chronic conditions?
Treatment Consent Form
When you arrive for your appointment, we will take your temperature and ask you to:
- Sanitize your hands
- Answer these questions again
- Complete the following Consent form