Symptom Screening Questionnaire

In accordance with Public Health guidelines, each person participating in an in-person appointment/entering an office space must complete the symptom screening questionnaire separately, no earlier than one day prior to your visit. Please answer all questions below and follow directives at the end of the questionnaire.

*If you require support to complete this assessment, please connect with your clinician/HPC staff.

Are you currently experiencing any of the following new or worsening symptoms or signs? (Symptoms should not be chronic or related to other known causes or conditions).


If you have answered NO to all the questions above you are permitted to proceed with your in-person/in-office appointment.

If you have answered YES to any of the questions above, you are not permitted to proceed with your in-person/in-office appointment. You should complete the provincial COVID-19 self-assessment at https://covid-19.ontario.ca/self-assessment. This will provide you with a recommendation from Public Health of next steps. Please contact your clinician to reschedule your appointment. If you require support to complete this assessment, please connect with your clinician/HPC staff.