COVID-19 | Rothwell Dental: Full Dental Services in Gloucester & Ottawa

Your first name *

Your last name *

Your age *

Did you receive your final (or second) vaccination dose more than 14 days ago? *YesNo

Do you have any of the following symptoms:

Fever and/or chillsNew onset of cough or worsening chronic coughShortness of breathDecrease or loss of sense of taste or smell18 years of age and over: Unexplained fatigue, lethargy, malaise, muscle aches (myalgias)18 years of age and under: Nausea, vomiting, diarrhea

Have you tested positive for COVID-19 in the past 10 days or have been told you should isolate? *YesNo

Have you travelled outside of Canada in the past 14 days? *YesNo

Have you tested positive to COVID-19 or had close contact with a confirmed case of COVID-19 without wearing appropriate PPE? *YesNo

Rothwell Dental Center – Bilingual Gloucester Ottawa Dental Services Dr. Andre Theoret

Cliquez ici pour le formulaire de dépistage COVID-19 en français

Do you have any of the following symptoms: