COVID Assessment Centre Intake Form

Please fill out this form and one of our nurses will contact you for an appointment. We are open from Monday to Friday and will try to respond the same day. For emergencies, please go to the nearest emergency department.

Please do not come without an appointment, as our doors are locked and you will not be seen.

Demographic information

Travel and contact history

If yes, please fill in the dates below.

COVID-19 Vaccination Status

Testing eligibility


Choose any/all that are new, worsening, and not related to other known causes or conditions.

In order to avoid delays in obtaining your COVID test results from the ministry’s website, verify that ALL information submitted is complete and accurate.