COVID-19 Screening FormPlease enable JavaScript in your browser to complete this form.Name: *Date: *Phone Number: *Have you travelled outside of Canada in the last 14 days? *YesNoHave you been near someone who has travelled outside of Canada in the last 14 days? *YesNoHave you had close contact with a confirmed or probable COVID-19 case? *YesNoExcluding pre-existing conditions, do you have any of the following symptoms: Fever, Cough, Shortness of breath, Sore throat, Nasal congestion, Runny nose, Loss of smell or taste, Pink eye, Nausea/vomiting, Diarrhea or Abdominal cramps? *YesNoPhoneSubmit
