COVID-19 Screener

Please complete the following COVID-19 Screening questionnaire prior to each appointment at the clinic. Please read carefully as our questions have changed as per the most recent guidelines.
Thank you for helping us limit the spread of COVID-19.
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COVID-19 Screener

How are you feeling today?

Please complete on the SAME day as your appointment.

My clinician:

Thank you for helping us limit the spread of COVID-19.