Covid-19 Screening

French Screening Form

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    COVID-19 Screening Results

    If response to ALL of the screening questions (other than 2) is NO: COVID Screen Negative. Your appointment will continue as scheduled. Please continue to follow all public health measures, including masking, maintaining physical distance, and hand hygiene, where applicable.

    If response to ANY of the screening questions (other than 2) is YES: COVID Screen Positive. Please contact Modern OT prior to your appointment to discuss whether an alternate arrangement needs to be made.

    Please complete and submit this form prior to your appointment. If you require assistance or have questions about this form, please contact Modern OT at 613-792-3461.

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