Important COVID-19 Announcement
COVID-19 Screening Book Now

Physiotherapy & Rehabilitation

COVID-19 Screening Questionnaire

For the health and safety of our therapists, staff and all others within the clinic, please answer all questions below honestly.
  • Name and Date

  • Date Format: MM slash DD slash YYYY
  • 1. In the last 14 days, have you...

  • **Exemptions from self-isolation (quarantine) orders include some essential workers and those that are fully immunized, if they have no symptoms.
  • ***Exemptions are in place for asymptomatic household members if they are an essential worker required to wear medical grade PPE while at work, such as health care workers and first responders.
  • If you have answered "yes" to any of the following questions please DO NOT ENTER
  • 2. Do you have any of the following “A symptoms?”

  • 3. Do you have 2 or more of the following “B Symptoms?”

  • If you answered yes to ANY of the above, please explain: