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 *

Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms? *

Yes No

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

Yes No

In the last 14 days, have you been identified as a “close contact” of someone who currently has COVID-19? Choose One *

Yes No

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

Yes No

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

Yes No

In the last 14 days, have you received a COVID Alert exposure notification on your cell phone? Choose One *

Yes No