POWER OUTAGE LINE:  902-543-2502

COVID-19 Pre-Screening Questionnaire

Please complete our COVID-19 screening 1 – 2 days before your scheduled in-person appointment. To help limit the risk of transmitting the COVID-19 virus, it is important we take measures to protect our technician's safety.
Name(Required)
MM slash DD slash YYYY
Address(Required)
Do you have(Required)
A fever (greater than 38°C) or fever-like symptoms: chills or sweats;
Do you have(Required)
A new or worsening cough.
Are you experiencing chills, fatigue, headache, sore throat, runny nose, stuffy or congested nose, lost sense of taste or smell, hoarse voice, difficulty swallowing or any digestive issues (nausea/vomiting, diarrhea, stomach pain)(Required)
Have you been in close contact with a confirmed or probable case of COVID-19(Required)
Have you been tested for COVID-19(Required)
Have you or anyone in your household traveled to a Canadian province or territory outside of Nova Scotia, PEI, or Newfoundland/Labrador within the past 14 days?(Required)
Have you or anyone in your household traveled outside of Canada?(Required)
Are you, or is anyone in your household, awaiting the results of a COVID-19 test?(Required)
Are you required for any reason to be self-isolating?(Required)