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CONFIDENTiAL CLIENT COVID-19

PRE-Screening form

Please fill out this form not less than 24 hours before your appointment. If your condition changes from the time you submit this form to your therapist and before your appointment time, please re-evaluate yourself before attending the appointment

confidential client COvid-19 pre-screening form

Please take the time to fill out the information below.

Signs of a fever:

  • in adults: 38°C (100.4°F) and above (oral temperature),

  • in older adults: 37.8°C (100°F) and above (oral temperature),

  • in children: 38°C (100.4°F) and above

  • or 1.1°C above the person's usual value

Do you have a fever?
In the past 14 days, did you return from travel outside of Canada, or did you have close contact with someone who is confirmed as having COVID-19?