COVID-19 Screening Questionnaire

Please correct the errors described below.

Screening Questions, In-Office:

Do you have any of the following symptoms:

  • Fever, new onset of cough or worsening chronic cough
  • Shortness of breath, chills or headaches
  • Difficulty breathing or swallowing
  • Sore throat, Pink eye
  • Decrease or loss of sense of taste or smell
  • Unexplained fatigue/malaise/muscle aches
  • Nausea/ vomiting, diarrhea, abdominal pain
  • Runny nose/nasal congestion without other known cause
  • Delirium
  • Unexplained or increased number of falls
  • acute functional decline
  • worsening of chronic conditions

Only patients should attend the office if possible. If possible, please wait in car until your appointment, call the office at (905)332-6950 when you arrive. If you develop any of the above symptoms within 14 days, please give us a call.

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