416.368.4858

info@downtowncore.ca

133 Richmond St. W, #606

(southwest corner of York & Richmond)

416.368.4858

info@downtowncore.ca

133 Richmond St. W, #606

(SW corner of York & Richmond)

Instagram @downtowncorechiropractic

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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 

416.368.4858

info@downtowncore.ca

133 Richmond St. W, #606

(SW corner of York and Richmond)