Mandatory Covid 19 Exposure Survey In according with AHS requirement, every client should fill Only clients who answer "NO" will be able to proceed with their appointments. If you answered "Yes" to one of the questions, please do not come to the clinic and contact us, so we can reschedule your appointment Next Question Title * 1. Have you been tested positive for Corona Virus in the last two weeks? Yes No Next Question Title * 2. Have you been in contact with someone tested positive for Covid 19 in the last two weeks? Yes No Next Question Title * 3. Have you experienced or been in contact with someone with flu-like symptoms in the last two weeks? Yes No Next Question Title * 4. Have you traveled outside Canada in the last two weeks? Yes No Next Question Title * 5. If you answered "NO" to all your questions please fill your contact info First Name Last Name Email Address Phone Number Next Question Title * 6. Your Appoint Date and time Date / Time Date Time AM/PM - AM PM Next DONE
