COVID-19 Appointment Screening Form
Please fill out and return this form in order to book an appointment.
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Email *
First and Last Name *
Address *
Phone Number *
Wedding Date *
MM
/
DD
/
YYYY
Number of Bridesmaids (For Bridesmaids appointments only)
Number of guests attending the appointment  with you? *
Please confirm the following statements *
Yes
No
Have you travelled outside of Canada in the last 14 days
Have you had close contact with somebody that has tested positive for covid-19
Have you been told to self isolate by your local public health unit?
Do you have a cough, fever or shortness of breath?
Do you have nasal congestion, runny nose or sneezing?
Do you have loss of taste or smell?
Do you have a sore throat or difficulty swallowing?
Do you have nausea, vomiting or diarrhea?
A copy of your responses will be emailed to the address you provided.
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