COVID-19 Waiver and Screening Form
Please complete this active screening process for each Medix College facility you visit for contact tracing purposes.
Please review the information below:
(1) Are you currently experiencing any of these symptoms?
(2) In the last 10 days, have you tested positive on a COVID-19 rapid antigen test, a self-testing kit or have been tested and are awaiting results?
(3) Have you been directed by Public Health, a physician or other healthcare professional to self-isolate for a period of time including today?
(3) In the last 14 days, have you had close contact* with someone who has or is suspected of having COVID-19 (including exhibiting any of the listed symptoms** and/or awaiting test results)?
By clicking an option below, I hereby certify the above information is accurate to the best of my knowledge.
Did you answer YES to ANY of the above questions?