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    • Dental Implants
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    • Comprehensive Care
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    • Dr. Paresh Shah
    • Dr. Neil Wilson
  • Meet Our Team
  • Contact

(204) 837-4517

Book Appointment

Call Today: (204) 837-4517
Book Appointment
  • Services
    • Digital Dentistry
    • Dental Implants
    • Aesthetics
    • Comprehensive Care
  • LECTURES & WORKSHOPS
  • Digital Smile Design
  • Smile Consult
  • Meet Our Doctors
    • Dr. Paresh Shah
    • Dr. Neil Wilson
  • Meet Our Team
  • Contact
  • Covid Prescreen Form

    If you have any questions, please call our office at 204-837-4517.

    Name :
     
    Date :
    Patient Screening Questions - Covid-19
     
    1.) Do you have any of the following symptoms:
    • Fever/chills
    • Shortness of Breath/Chest pain
    • Sore throat
    • Dry cough
    • Congestion
    • Drowsiness
    • Loss of consciousness/confusion
    Yes
    No
     
    2.) Have you been in contact with someone known to have tested positive with COVID-19?
    Yes
    No
     
    3.) Have you had any contact with laboratory samples known to contain COVID-19?
    Yes
    No
     
    4.) Have you been in a large group setting in Manitoba in the last 14 days?
    Yes
    No
     
    5.) Have you traveled outside of Manitoba in the last 14 days?
    Yes
    No
     
    If so, were you in any large group settings?
    Yes
    No
     
    6.) Are you or someone you live with a health care worker/first responder?
    Yes
    No
     
    7.) Do you or someone you live with work in a correctional facility,shelter,personal care home?
    Yes
    No
     
     
    8.) Has a member of your household been identified as a close-contact and instructed to self-isolate (quarantine) by public health officials,and they are not able to isolate from you?
    Yes
    No
     
     
     
     
     

    6-3421 Portage Ave.
    Winnipeg, MB R3K2C9

    204-837-4517

    admin.westwood@mymts.net

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