COVID QUESTIONNAIRE-London East Medical Centre

COVID QUESTIONNAIRE-London East Medical Centre


COVID-19 Safety Screening Questions for Patients

Please review all questions prior to your apointment.  If you answer 'Yes' to any of the questions, please do not come to the office and we ask that you self-isolate at home immediately and contact their health care provider or Telehealth Ontario (1 866-797-0000) to find out if you need a COVID-19 test.   If you answer 'No' to all questions, then you can attend your appointment as planned.

Required Screening Questions:

1.  Do you have any of the following new or worsening symptoms or signs? Symptoms should not be chronic or related to other known causes or conditions.
Fever or chills  Yes  or  No
Difficulty breathing or shortness of breath  Yes  or  No
Cough  Yes  or  No
Sore throat, trouble swallowing  Yes  or  No
Runny nose/stuffy nose or nasal congestion  Yes  or  No
Decrease or loss of smell or taste  Yes  or  No
Nausea, vomiting, diarrhea, abdominal pain  Yes  or  No
Not feeling well, extreme tiredness, sore muscles  Yes  or  No
2.  Have you travelled outside of Canada in the past 14 days?  Yes  or  No
3.  Have you had close contact with a confirmed or probable case of COVID-19?  Yes  or  No