Customer Screening

COVID 19 PROCEDURE

Be Safe
Our Commitment

For the safety of our staff and you, please complete the following form prior to our visit or service. Read our full COVID-19 procedure for all details.

COVID19-Customer

First Name

Last Name

Phone/Mobile

Have you travelled outside Canada since March 12, 2020?

Yes

Do you or any member of your family have the following symptoms
(please select all that apply)

Fever

Yes

Coughing

Yes

Difficulty Breathing

Yes

Have you been exposed to a person who has a confirmed or probable case the Covid-19 in the last 30 days?

Yes

By submitting this form, you are declaring that the information provided herein is accurate, correct, and complete and that the responses submitted within this form are genuine.