COVID-19 Screening Questionnaire Have you tested positive for COVID-19?*YesNoAre you awaiting results for a COVID-19 test?*YesNoDo you have a fever over 38°C (100.4°F) or chills?*YesNoDo you have a new or worsening cough?*YesNoDo you have a sore throat?*YesNoDo you have a runny nose or nasal congestion that you wouldn't normally have because of seasonal allergies or another pre-existing condition?*YesNoDo you have other cold- or flu-like symptoms?*YesNoAre you having new or worsening shortness of breath or other difficulties breathing?*YesNoHave you experienced a recent loss of taste or smell?*YesNoAre you feeling tired or fatigued without explanation?YesNoDo you have a new or worsening headache?*YesNoDo you have nausea, vomiting, diarrhea, or abdominal pain?*YesNoEven if you do not currently have any of the above symptoms, have you experienced any of these symptoms in the last 14 days?*YesNoIn the past 14 days, have you been in close contact with any suspected or confirmed COVID-19 patients without personal protective equipment?*YesNoDo you have cardiovascular disease, lung disease (including moderate to severe asthma), kidney disease, or diabetes?*YesNoAre you immunocompromised?*YesNoHave you returned from travel outside the province in the past 14 days?*YesNoAre you over 60 years of age?*YesNoYour Name*Your Phone Number*CommentsThis field is for validation purposes and should be left unchanged.