COVID-19 Screening Form We take every precaution for your safety! 3 COVID-19 SCREENING FORM Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone *Email *Are you exhibiting any of the following symptoms? *Fever or chillsDifficulty breathing or shortness of breathCoughSore throat, trouble swallowingRunny nose/stuffy nose or nasal congestionDecrease or loss of smell or tasteNausea, vomiting, diarrhea, abdominal painNot feeling well, extreme tiredness, sore musclesNone of the aboveHave you traveled outside of Canada in the past 14 days? *YesNoSignature *Clear SignatureDate *Submit
