COVID-19 Screening

Before visiting Secura, we ask that you complete this short screening form. In accordance with Ontario guidelines, we must actively screen all persons, whether or not they have been vaccinated.

Once the form is submitted, a receipt of your responses will automatically be forwarded to our staff. Thank you for taking the time to keep everyone safe!

1) Are you currently experiencing one or more of the symptoms below that are new or worsening? Symptoms should not be chronic or related to other known causes or conditions.


Fever and/or Chills
Cough or barking cough (croup)
Shortness of breath
Decrease or loss of smell or taste
Fatigue. lethargy, malaise and/or myalgias

2) In the last 14 days, have you travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements)?

3) Has a doctor, health care provider, or public health unit told you that you should currently be isolating (staying at home)?


This can be because of an outbreak or contact tracing

4) In the last 10 days, have you been identified as a “close contact” of someone who currently has COVID-19?


If public health has advised you that you do not need to self-isolate (e.g., you are fully immunized* or have tested positive for COVID-19 in the last 90 days and since been cleared), select “No.”

5) In the last 10 days, have you received a COVID Alert exposure notification on your cell phone?


If you have already gone for a test and got a negative result, select "No." If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select "No."

6) In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit?


If you have since tested negative on a lab-based PCR test, select “No.”

7) In the last 14 days, has someone in your household (someone you live with) travelled outside of Canada AND been advised to quarantine (as per the federal quarantine requirements) in the last 14 days


If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No.”

8) In the last 10 days, has someone in your household (someone you live with) been identified as a ”close contact” of someone who currently has COVID-19 AND advised by a doctor, healthcare provider or public health unit to self-isolate in the last 10 days?


If you are fully immunized or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No.

9) Is anyone you live with currently experiencing any new COVID-19 symptoms and/or waiting for test results after experiencing symptoms?


If the individual experiencing symptoms received a COVID-19 vaccination in the last 48 hours and is experiencing mild fatigue, muscle aches, and/or joint pain that only began after vaccination, select “No.” If you are fully vaccinated or have tested positive for COVID-19 in the last 90 days and since been cleared, select “No.”

If you selected "No" to all of the questions above, we look forward to seeing you at Secura! Thank you for your time.