Covid-19 Screening

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Covid-19
- Covid-19 Screening
Location & Contact

Home
About
Book Now
Services
Covid-19
- Covid-19 Screening
Location & Contact

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TedThomasR.M.T

Home
About
Book Now
Services
Covid-19
- Covid-19 Screening
Location & Contact

Covid-19 Pre-Appointment Screening

* Indicates required field

Name *

First

Last

Email *

Do you have a fever? *

Yes No

Do you have any of the following new or worsening symptoms or signs? *

Unexplained fatigue/malaise Headache Chills New or worsening cough Hoarse Voice Sore Throat Shortness of breath Difficulty Swallowing Runny nose, sneezing or nasal congestion New smell or taste disorder(s) Nausea/vomiting, diarrhea, abdominal pain

Select all that apply.

Have you traveled outside of Canada or had close contact with anyone that has traveled outside of Canada in the past 14 days? *

Yes No

Have you had close contact with anyone with respiratory illness or a confirmed or probable case of COVID-19? *

Yes No (Screening Complete)

Did you wear the required and/or recommended PPE according to the type of duties you were performing (e.g., goggles, gloves, mask and gown or N95 with aerosol generating medical procedures (AGMPs) when you had close contact with a suspected or confirmed case of COVID-19? *

Yes No Not Applicable

Submit

NB: If you feel unwell or are experiencing any of the above symptoms do not book an appointment or reschedule your appointment. For the health and safety of myself and other clients, do not come to your appointment. There is no penalty. I will reschedule your appointment if you cannot do so yourself.

​Covid-19 Pre-Appointment Screening

Ted Thomas Registered Massage Therapist. All Rights Reserved Copyright' 2022

Covid-19 Pre-Appointment Screening