Use this form before your appointment.
Please answer the following screening questions.
When you arrive at the office, you will be asked to :
- Sanitize your hands.
- Have your temperature taken.
* Factors such as old age, diabetes and end-stage renal disease are generally not considered immunocompromised. Examples of being immunocompromised include individuals:
- undergoing cancer chemotherapy
- with untreated HIV infection with CD4 T lymphocyte count less than 200
- with combined primary immunodeficiency disorder
- on prednisone medication - more than 20 mg per day (or equivalent) for more than 14 days
- on other immune suppressive medications
** select "NO" if all of these apply :
- you do not have a fever, AND
- your symptoms have been improving for 24 hours (48 hours if you have nausea, vomiting, and/or diarrhea)