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How are you feeling today? Please complete this form no more than 48 hours before your scheduled appointment.
Fever and/or chills
Coughing or barking cough
Shortness of breath
Decrease or loss of sense of taste or smell
Muscle aches or joint pain
Extreme tiredness
Sore throat
Runny or stuffy/congested nose
Headache
Nausea, vomiting and/or diarrhea
- You live with someone who is currently isolating because of a positive COVID-19 test
- You live with someone who is currently isolating because of COVID-19 symptoms
- You live with someone who is isolating while waiting for COVID-19 test results
905-503-8686
Check the box if the answer is NO