Covid Screening Test
Patient Information
The fields with a * are mandatory
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Mobile Number
Please fillout at least one of the phone number fields - we may contact you for a follow up assessment via phone
Phone Number
ON (Ontario)
Consent
Questionnaire

  • Fever and/or chills
  • Cough
  • Shortness of breath
  • Decrease or loss of smell or taste

If you received a COVID-19 vaccine in the last 48 hours and are experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination select 'No'

  • Extreme fatigue, lethargy, or malaise
  • Muscle aches or joint pain
  • Nausea, vomiting and/or diarrhea
  • Sore throat
  • Runny nose/nasal congestion
  • Headache

If you received a COVID-19 vaccine in the last 48 hours and are experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination select 'No'

  • Hospitalized patients
  • Patients seeking emergency medical case, at the discretion of the treating clinician
  • Patient-facing healthcare workers
  • Staff, volunteers, residents/inpatients, essential care providers, and visitors in hospitals and congregate living settings, including Long-Term Care, retirement homes, First Nation elder care lodges, group homes, shelters, hospices, temporary foreign worker settings, and correctional institutions
  • Outpatients for whom COVID-19 treatment is being considered (includes those 70 and older who have a risk factor including obesity (BMI >= 30), dialysis or stage 5 kidney disease (eGFR < 15 mL/min/173 m2), diabetes, cerebral palsy, intellectual disability of any severity, sickle cell disease, receiving active cancer treatment, solid organ or stem cell transplant recipients, or 50 and older if First Nations, Inuit, or Metis with any of those risk factors).
  • People who are underhoused or homeless

  • First Nation, Inuit, and Métis communities and individuals travelling into these communities for work
  • People on admission/transfer to or from hospital or congregate living setting
  • High risk contacts and asymptomatic/symptomatic people in the context of confirmed or suspected outbreaks in highest risk settings, including hospitals, long-term care, retirement homes, other congregate living settings and institutions, and other settings as directed by the local public health unit
  • Individuals, and one accompanying caregiver, with written prior approval for out-of-country medical services from the General Manager, OHIP
  • Asymptomatic testing in hospital, long-term care, retirement homes and other congregate living settings and institutions as per provincial guidance and/or Directives, or as directed by public health units

  • Aged 18 and over and is immunocompromised (have an immune system that is weakened by a health condition or medications)
  • Aged 70 and over
  • Aged 60 and over with TWO OR LESS vaccine doses

  • Obesity (BMI >= 30)
  • Dialysis or stage 5 kidney disease (eGFR <15 mL/min/1.73 m2)
  • Diabetes
  • Cerebral Palsy
  • Intellectual disability of any severity
  • Sickle cell disease
  • Receiving active cancer treatment
  • Solid organ or stem cell transplant recipients