COVID19 Screening
Please note, if you answer YES to any of the screening questions, we will not be able to serve you today.
Sign in to Google to save your progress. Learn more
Do you have any of the following new or worsening symptoms or signs? Fever, Chills, Cough, Trouble Breathing, Sore Throat, Trouble Swallowing, Runny Nose, Loss of Taste or Smell, Nausea, Vomiting, Diarrhea, Pink Eye, Headache, Tired, Sore Muscles or Joints? *
In the last 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit? *
Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *
In the last 14 days, have you traveled outside of Canada and been told to quarantine (per the federal quarantine requirements)? *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy