COVID-19 Screening Tool

• Severe difficulty breathing
  (struggling for each breath, can only speak in single words)
• Severe chest pain
  (constant tightness or crushing sensation)
• Feeling confused or unsure of where you are
• Losing consciousness

• Fever and/or chills
  Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher
• cough or barking cough (croup)
  Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, COPD, or other known causes or conditions you already have)
• Shortness of breath
  Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions you already have)
• Decrease or loss of sense of taste or smell
  Not related to seasonal allergies, neurological disorders, or other known causes or conditions you already have
• Muscle aches/joint pain
  Unusual, long-lasting (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, a sudden injury, fibromyalgia, or other known causes or conditions you already have)
• Extreme tiredness
  Unusual, fatigue, lack of energy (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, depression, insomnia, thyroid dysfunction, or other known causes or conditions you already have)
• Sore throat
  Painful or difficulty swallowing (not related to post-nasal drip, acid reflux, or other known causes or conditions you already have)
• Runny or stuffy/congested nose
  Not related to seasonal allergies, being outside in cold weather, or other known causes or conditions you already have
• Headache
  New, unusual, long-lasting (not related to getting a COVID-19 vaccine and/or flu shot in the last 48 hours, tension-type headaches, chronic migraines, or other known causes or conditions you already have)
• Nausea, vomiting and/or diarrhea
  Not related to irritable bowel syndrome, anxiety, menstrual cramps, medication side effects, or other known causes or conditions you already have

• been sick with symptoms associated with COVID-19?
  and/or
• tested positive for COVID-19 (on a rapid antigen test or PCR test)?

COVID Screen Result

Thank you for taking the time to complete these questions. Based on your answers, RMTs cannot provide treatment at this time.

COVID Screen Result

Based on your answers, you do not need to self-isolate or get tested.

Thank you for taking the time to complete these questions.