Skip to content
PLEASE READ CAREFULLY  
 
COVID-19 SELF-SCREENING QUESTIONNAIRE  
 
All visitors to the Clinic must complete a COVID-19 Self-screening questionnaire, as well as provide proof of the screening at your appointment.  Self-Screening forms are available below in both a printable and via QR Code.  Please click on the preferred link below.   Please note the COVID-19 Self-screening QR Code is also posted at the main entrance, as well as throughout the building for your convenience.  
 
PRINTABLE COVID-19 PATIENT SCREENING CHECKLIST  
QR Self-Screening Questions  
 
If you have an appointment at The Peterborough Clinic AND if you do not pass the screening, 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  
 
Stop COVID Logo  
 
Vaccine Exemption Guidelines  
 
   
 
 

COVID19 Self-Screening QR Code