Port Perry Covid-19 Health Declaration
How are you feeling today? Please complete this form no more than 48 BUSINESS hours before your scheduled appointment.
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Fever and/or chills
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New onset of cough / Worsening chronic cough
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Shortness of breath
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Decrease or loss of sense of taste or smell
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If adult >18 years of age : unexplained fatigue/lethargy/malaise/muscle aches (mylagia)
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If child < 18 years of age : nausea/vomiting, diarrhea
If this form cannot be submitted, please call the office directly.