Self-assesment

Please read the following screening self-assessment the day of and prior to your appointment.

If you answer NO TO ALL of these please proceed with your appointment. Otherwise, please cancel your appointment and contact Public
Health immediately. DO NOT show up at clinic.
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1.) Are you currently experiencing any of these symptoms (new, worsening, and not related to a medical condition you already have?)
● Fever
● New onset of cough
● Worsening chronic cough
● Shortness of breath
● Difficulty breathing
● Sore throat
● Difficulty swallowing
● Decrease of loss of sense of taste or smell
● Chills
● Headaches
● Unexplained fatigue/malaise/muscle aches (myalgias)
● Nausea/vomiting, diarrhea, abdominal pain
● Pink eye (conjunctivitis)
● nose or nasal congestion without other known cause
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2. Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test
results after experiencing symptoms?
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3.) Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?

This can be because of an outbreak or contact tracing.