COVID-19 Pre Screening Form

The clinic has decided to continue making masks MANDATORY effective June 11th 2022 until further notice.

Q1: Do you have any of the following symptoms?

  • Fever and/or chills
  • Cough or barking cough (croup)
  • Shortness of breath
  • Muscle aches/joint pain
  • Extreme tiredness
  • Sore throat
  • Runny or stuffy/congested nose
  • Headache
  • Nausea, vomiting or diahrrea
  • Decrease or loss of sense of taste or smell

> If yes, we are unable to treat you at this time.
Please reschedule your appointment for 2+ weeks in the future by emailing us at epionemassagetherapy@gmail.com

Q2: Have you tested positive for COVID-19 in the past 10 days or have you been told you should be isolating?
> If no, please proceed to question 3
> If yes, we are unable to treat you at this time. Please reschedule your appointment for 2+ weeks in the future by emailing us at epionemassagetherapy@gmail.com

Q3: Did the you receive your final (or second) vaccination dose more than 14 days ago?
> If no, please proceed to question 4
> If yes, you have screened NEGATIVE. You may continue with your appointment as scheduled

Q4: Did you travel outside of Canada in the past 14 days?
> If no, please proceed to question 5
> If yes, we are unable to treat you at this time. Please reschedule your appointment for 2+ weeks in the future by emailing us at epionemassagetherapy@gmail.com

Q5: Have you had close contact with a confirmed case of COVID-19 without wearing appropriate PPE?
> If no, you have screened NEGATIVE. You may continue with your appointment as scheduled
> If yes, we are unable to treat you at this time. Please reschedule your appointment for 2+ weeks in the future by emailing us at epionemassagetherapy@gmail.com