COVID QUESTIONNAIRE-London East Medical Centre
Please review all questions prior to your apointment. If you answer 'Yes' to any of the questions, please do not come to the office and we ask that you self-isolate at home immediately and contact their health care provider or Telehealth Ontario (1 866-797-0000) to find out if you need a COVID-19 test. If you answer 'No' to all questions, then you can attend your appointment as planned.
Required Screening Questions:
1. Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.
Fever or chills Yes or No
Difficulty breathing or shortness of breath Yes or No
Cough Yes or No
Sore throat, trouble swallowing Yes or No
Runny nose/stuffy nose or nasal congestion Yes or No
Decrease or loss of smell or taste Yes or No
Nausea, vomiting, diarrhea, abdominal pain Yes or No
Not feeling well, extreme tiredness, sore muscles Yes or No
2. Have you travelled outside of Canada in the past 14 days? Yes or No
3. Have you had close contact with a confirmed or probable case of COVID-19? Yes or No