COVID-19 Screening (Ministry of Health Ontario)


This screening tool is based on the latest COVID-19 case definitions and situation reports published by the World Health Organization. This is used to screen people who are suspected or confirmed of having COVID-19 throughout the health and emergency response system. Ensuring all health and safety providers are following the same screening protocol will help ensure consistency when dealing with suspected or confirmed cases of COVID-19.

Last updated: June 11, 2020. Sourced from: link


Please Write Your Full Name (or Guardian's Name) as an Electronic Signature *
Phone Number (e.g. 4167223393) *
Email Address (e.g. name@email.com) *
1. Did you travel outside of Canada in the last 14 days? *


2. Have you tested positive for COVID-19, or had close contact with a confirmed case of COVID-19 without wearing appropriate PPE (Personal Protective Equipment)? *
*Close contact: being less than 2 metres away in the same room, workspace, or area for over 15 minutes, and/or living in the same home


3. Do you have any of the following symptoms? (Check all that applies) *
















4. If you are 70 years of age or older, are you experiencing any of the following symptoms: delirium, unexplained or increased number of falls, acute functional decline, or worsening of chronic conditions?



5. Date of Service Visit *


Make an appointment

Leave your contacts here and we contact you as fast as we can!

Location

Address

403 Parliament St,
Toronto, ON M5A 3A1

Hours

Monday - Friday
9AM - 6PM
Saturday
10AM - 4PM

Phone

+1 (416) 274-7979

E-mail

info@parliamentphysio.ca
Copyright © Parliament Physio Clinic 2013-2021. All rights reserved. DEVELOPED BY MYBLACK.RU