Covid-19 Questionnaire

Please fill out the following form to help us understand your physical condition.

Fever or Chills
Cough
Decrease or loss of smell or taste?
Nausea, vomiting, diarrhea, abdominal pain?
Difficulty Breathing or Shortness of Breath
Sore throat, trouble swallowing?
Runny nose/stuffy nose or nasal congestion?
Not feeeling well, extreme tiredness, sore muscles?
Have you travelled outside of Canada in the past 14 days?
Have you had close contact with a confirmed or probable case of Covid-19?

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