COVID Screening

Please fill out our COVID Screening Survey the day of your class before visiting us... namaste!

* Indicates required field

Name *

First

Last

Email *

In the last 10 days. has someone you live with: *

Been sick with symptoms associated with COVID-19? and/or Tested positive for COVID-19 (on a rapid antigen test or PCR test? None of the above

In the last 10 days, have you tested positive on a rapid antigen test or home-based self-testing kit? *

Yes No

In the last 10 days, have you received a COVID Alert exposure notification on your cell phone? *

Yes No

In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19? Confirmed by a PCR or rapid antigen test. *

Yes No

In the last 14 days, have you travelled outside of Canada? *

Yes No

Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)? *

Yes No

Have you been in close physical contact with someone experiencing symptoms of COVID in the last 10 days? *

Yes No