top of page
home
contact us
More
Use tab to navigate through the menu items.
Covid-19 Health Declaration
How are you feeling today?
First Name
Last Name
Email
My body temperature is lower than 98.6°F/ 37.5°C
I am not experiencing the following symptoms: fever, cough, sore throat, shortness of breath, runny nose, general feeling of being unwell
I have not been in close contact with a Covid-19 positive patient in the last 14 days
I have not been outside of Canada in the past 14 days
Initials
Date
I declare that the info I’ve provided is accurate & complete
Submit
Thanks for submitting!
bottom of page
