COVID-19 Customer Screening Your personal details First Name* Last Name* Email* Address City Province Postal/Zip Code Primary Phone* COVID-19 Screening Do you have new or worsening symptoms or signs of fever or chills?* Do you have new or worsening symptoms or signs of a cough?* Do you have new or worsening symptoms or signs of runny nose/stuffy nose or nasal congestion?* Do you have new or worsening symptoms or signs of nausea, vomiting, diarrhea, abdominal pain?* Have you travelled outside of Canada in the past 14 days?* Do you have new or worsening symptoms or signs of difficulty breathing or shortness of breath?* Do you have new or worsening symptoms or signs of sore throat, trouble swallowing?* Do you have new or worsening symptoms or signs of decrease or loss of smell or taste?* Do you have new or worsening symptoms or signs of not feeling well, extreme tiredness, sore muscles?* Have you had close contact with a confirmed or probable case of COVID-19?* What Department or Sales Executive Are You Here To See?* I wish to receive further information from your organization. I am aware that I may unsubscribe to such information at any time.*