Telephone Assessment Request

Testing will NOT change the course or treatment of the illness of COVID 19.
Anyone with respiratory symptoms MUST self-isolate for 10 days regardless of testing.
Anyone arriving in Canada MUST self isolate for 14 days.
The purpose of the assessment visit is to assess and manage any urgent respiratory symptoms as well as assess, educate and test for COVID 19 as per Provincial Guidelines.

It is by all of us working together to SOCIAL distance that will keep our community safe. Thank you for doing your part #stayhome #socialdistance #missionstrong!

Testing will NOT change the course or treatment of the illness of COVID 19.
Anyone with respiratory symptoms MUST self-isolate for 10 days regardless of testing.
Anyone arriving in Canada MUST self isolate for 14 days.
The purpose of the assessment visit is to assess and manage any urgent respiratory symptoms as well as assess, educate and test for COVID 19 as per Provincial Guidelines.

It is by all of us working together to SOCIAL distance that will keep our community safe. Thank you for doing your part #stayhome #socialdistance #missionstrong!

Patient Acknowledgement and Agreement:
I acknowledge that I have read and fully understand the risks, limitations, conditions of use, and instructions for use of the selected electronic communication Services more fully described in the CMPA Consent Form. I understand and accept the risks outlined in the CMPA Consent Form, associated with the use of the Services in communications with the Physician and the Physician’s staff. I consent to the conditions and will follow the instructions outline in the CMPA Consent Form, as well as any other conditions that the Physician may impose on communications with patients using the Services.
I acknowledge and understand that despite recommendations that encryption software be used as a security mechanism for electronic communications, it is possible that communications with the Physician and/or the Physician’s staff using the Services may not be encrypted. Despite this, I agree to communicate with the Physician or the Physician’s staff using these Services with a full understanding of the risk. I acknowledge that either I or the Physician may, at any time, withdraw the option of communicating electronically through the Services upon providing written notice. Any questions I had have been answered.