COVID-19 Questionnaire

Coronavirus COVID-19 Information

For the safety of our staff and you (the patient) please answer these questions to the best of your ability.

1. Do you have a fever (38 degrees C or 100.4 degrees F and above)?

2. Do you have any of the following symptoms?

  • Sore throat
  • New onset of cough
  • Worsening chronic cough
  • Shortness of breath
  • Difficulty breathing or swallowing
  • Decreased sense of taste or smell
  • Chills
  • Nausea/vomiting, diarrhea, abdominal pain
  • Pink eye (conjunctivitis)
  • Runny nose or nasal congestion

3. Have you or anyone in your household travelled outside of Canada in the past 14 days?

4. Have you had close contact with anyone with respiratory illness or a confirmed or suspected case of COVID-19?

If the response to any of the screening questions is yes then unfortunately we will have to reschedule your appointment when it is safe for yourself and your therapist. Please call 811, go to or contact your physician.