Name* Email* Phone number* Date* Are you currently experiencing any of the following symptoms; Fever, chill, high temperature Cough Shortness of breath Decreaese of smell or taste Nausea, vomiting, diarrhea NoYes In the last 14 days have you travelled outside Canada AND been advised to quarantine? NoYes Has a health care provider told you that you should be isolating? NoYes In the past 14 days have you been identified as a “close contact” of someone who has Covid? NoYes In the past 10 days have you tested positive on a Covid test? NoYes
