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COVID19 VACCINE EFFICACY INFORMATION!   Please click here.  
 
For additional vaccination information, please click here.Stop COVID Logo  
 
Vaccine Exemption Guidelines  
 
COVID19 VACCINE AFTER CARE SHEET - Please click COVID-19_vaccine_after_care_sheet.  
 
PRINTABLE COVID-19 PATIENT SCREENING CHECKLIST v5 July 30 2021  
MOBILE COVID-19 PATIENT SCREENING CHECKLIST SUBMISSION FORM  
 
PLEASE READ CAREFULLY  
The Peterborough Clinic is working to enhance what we’re doing to protect our patients and caregivers and prevent the spread of COVID-19  
 
If you have an appointment at The Peterborough Clinic AND you (or close contact) have travelled outside of Canada or you are feeling unwell and experiencing flu-like symptoms (Including, but not limited to, fever, cough and/or difficulty breathing)   Please stay home and call your physician’s office for further direction.  
 
You may also contact the Peterborough Public Health and speak with a nurse regarding your symptoms as well.   Please call: 705-743-1000   Ext.401  
 
If you are in distress, please call 911.  
 
Regards,  
The Peterborough Clinic  
 
 
   
 

COVID-19 Online Screening Form

Click here if you would like to print and fill out a PDF version

    COVID-19 PATIENT SCREENING CHECKLIST:
    Patients who wish to skip the line for screening, may complete this COVID-19 Checklist before arriving at the Clinic for their appointment and provide it to the screening team at the front entrance. Checklists will be kept strictly confidential by The Peterborough Clinic.

    In order to enter the clinic for any reason you must meet the following conditions: Check
       1) I am wearing a mask Yes
       2) I am alone – no visitors unless you require one (1) personal care provider Yes
       3) I did not arrive early – no more than 5 minutes before your appointment Yes
       4) I am not wearing gloves – you will be required to sanitize your hands Yes
     
    Do not come to the clinic if you answer "yes" to ANY of these questions.
       1. Do you have any new /worsening COVID-19 symptoms?
          fever, cough, difficulty breathing,       sore throat, unexplained congestion,
          loss of taste/smell, difficulty swallowing, unexplained headache/fatigue/muscle aches,
          diarrhea, pink eye, abdominal pain, nausea/vomiting, (if you are > 70 yrs delirium,
          falling down, functional decline, worsening chronic conditions)
    Yes DO NOT COME TO THE CLINIC
       2. Are you awaiting a COVID-19 PCR test result due to symptoms/positive rapid test? Yes DO NOT COME TO THE CLINIC
       3. Have you been advised to self-isolate for any reason?
          (i.e. close contact with COVID-19 case, outbreak, etc.)
    Yes DO NOT COME TO THE CLINIC
       4. Have you, or someone you live, with travelled outside Canada in the past 14 days AND are required to quarantine per the federal quarantine requirements? Yes DO NOT COME TO THE CLINIC
    Name:
    Email:
    Date:
    Yes I have read and completed the above checklist:

    Please Note:

    The Peterborough Clinic is fully accessible. If you require the use of the elevator, it is currently restricted to one person (plus one caregiver if necessary). This measure is in place to provide physical distancing to stop the spread of COVID-19. Please inform the screener at the front entrance if you require the use of the elevator as additional wait time may be required. Stairs are encouraged for anyone who does not need the elevator to reduce wait times.