Ontario Ministry of Health COVID-19 Patient Screening Updated August 26, 2021
Your First and Last Name (required)
Today's Date (required)
Did you receive your final (or second) vaccination dose more than 14 days ago?
Have you travelled outside Canada in the last 14 days?
Have you had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?
Have you tested positive for COVID-19 in the past 10 days or have you been told you should be isolating?
Do you have any of the following COVID-19 symptoms? (please check all that apply)
Fever and/or chills
New onset of cough or worsening chronic cough
Shortness of breath
Decrease or loss of sense of smell or taste
If an adult >18 years of age: unexplained fatigue/lethargy/malaise/muscle aches
If a child <18 years of age: nausea/vomiting, diarrhea
Thank you for completing this COVID-19 screening prior to your appointment. We appreciate your help and cooperation.