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Covid-19 Health Declaration
How are you feeling today?
First Name
Last Name
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I am not experiencing the symptoms: fever, cough, sore throat, runny nose
I have not travelled outside of Canada in the past 14days
I have not been in close contact with a Covid-19 patient in the last 14 days
I or anyone in my household have not been in close contact with anyone who has taken a Covid-19 test in the last 14 days
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Date
I declare that the info I’ve provided is accurate & complete. I acknowledge that misrepresentation puts others at risk.
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