Do you have any of the following new or worsening symptoms or signs? Severe difficulty breathing, Severe chest pain, Feeling confused or unsure of where you are, Losing consciousness, Fever, Chills, Cough that's new or worsening, Barking cough, making a whistling noise when breathing, Shortness of breath, Sore throat, Runny nose, Stuffy or congested nose, Decrease or loss of taste or smell, Pink eye, Headache that’s unusual or long lasting, Digestive issues like nausea/vomiting, diarrhea, stomach pain, Muscle aches that are unusual or long lasting, Extreme tiredness that is unusual, Falling down often, Sluggishness or lack of appetite.
Yes No
Have you travelled outside of Canada in the last 14 days?
Yes No
In the last 14 days, have you been in close physical contact with someone who currently has COVID-19?
Yes No
