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chiropractic . medical acupuncture
COVID-19 Screening Questionnaire
1. Have you received your final (or second) vaccination dose more than 14 days ago?
* A fully immunized individual is defined as any individual >14 days after receiving their second dose of a two-dose COVID-19 vaccine series or their first dose of a one-dose COVID-19 vaccine series (i.e .Johnson and Johnson).
2. Do you have any of the following symptoms:
• Fever and/or chills
• New onset of cough or worsening chronic cough
• Shortness of breath
• Decrease or loss of sense of smell or taste
• For adults (>18 years of age): Unexplained fatigue/lethargy/malaise/muscle aches (myalgias)
• For child (< 18 years of age): Nausea/vomiting, diarrhea
3. Have you tested positive for COVID-19 in the past 10 days or have you been told you should be isolating?
If you are not fully immunized please answer questions 4 & 5:
4. Have you travelled outside of Canada in the past 14 days?
5. Have you had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?
chiropractic . medical acupuncture