Health Screening Questionnaire

Please answer the following questions at least 6 hours prior to your appointment at Calgary Pilates. If your appointment is a virtual appointment via Zoom, there is no need to complete the questionnaire.

Your Email Address

Do you have any of the below symptoms: Do you have any of the below symptoms: Fever greater than 38.0 C Cough Shortness of breath/difficulty breathing Sore throat Runny nose None of the above mentioned symptoms

Have you, or ANYONE in your household traveled outside Canada in the last 14 days? Have you, or ANYONE in your household traveled outside Canada in the last 14 days? Yes No

Have you or ANYONE in your household been in contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? Have you or ANYONE in your household been in contact in the last 14 days with someone who is being investigated or confirmed to be a case of COVID-19? Yes No

Are you currently being investigated as a suspect case of COVID-19? Are you currently being investigated as a suspect case of COVID-19? Yes No

Have you tested positive for COVID-19 within the last 10 days? Have you tested positive for COVID-19 within the last 10 days? Yes No