FORM 2 - COMPLETE THIS FORM TO CONFIRM THE APPOINTMENT
In response to COVID-19, additional steps have been taken to further enhance your safety and the safety of our staff.
Email address *
Full Name: *
Accompanying persons are not permitted to enter, except for caregivers.
Delivery Personnel are to contact the facility staff prior to entering.
Please review the following questions to confirm your fitness to enter the facility.
Do you currently have any of the following symptoms?
Severe Cough? *
Muscle pains? *
Significant Nasal Congestion? *
Fever > 38°C? *
Shortness of breath? *
Headache? *
Runny nose? *
Reduced or lost sense of smell? *
Have you failed to use physical distancing in the last two weeks? *
Have you come into contact with anyone suspected of having Covid-19 in the last 2 weeks? *
Have you come into contact with anyone diagnosed of having Covid-19 in the past 2 weeks? *
If you answered "YES" to any of the above questions,
Call our number below and you will be given the appropriate direction.
Only enter the clinic if you answered "No" to all the questions above.
Call us if you have any questions: 905 770 2006
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