VISITORS COVID-19 SCREENING

Kuture Cuts & Culture 411 Manhattan Drive, Markham, ON

Carefully read the list of COVID-19 symptoms below. Please verify your status in relation to these symptoms and be sure to let us know before your scheduled appointment of any changes.

I am completing this screening questionnaire on behalf of:

  • Do you have any COVID-19 related symptoms?

Common symptoms may include:

- fever

- new onset of cough

- chills

- unexplained fatigue

- sore throat

- runny nose

- stuffy or congested nose

- lost sense of taste or smell

- difficulty breathing

- difficulty swallowing

- pink eye

- digestive issues (nausea/vomiting,

  diarrhea, stomach pain), or

- for young children and infants:

  sluggishness or lack of appetite

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  • Have you returned from travel in the last 14 days or been in close contact with someone who has travelled?

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  • Have you been in close contact with someone who has tested positive for COVID-19?

If you answer ‘yes’ to any of the above screening questions, your appointment should be re-scheduled and you should contact either your health care provider, Telehealth Ontario (1-866-797-0000), or visit an Assessment Centre for testing.

SCREENING VERIFICATION

In order to proceed with your scheduled appointment, check the box to confirm that you are free of symptoms.

© KUTURElife 2020