COVID-19 Screening Tool

This tool can help you understand what to do next about COVID-19.

Let’s all look out for each other by knowing our status, trying not to infect others, and reserving care for those in need.

You’ll answer a few questions about symptoms, travel, and contact you’ve had with others.

Your answers will not be shared with anyone without your permission.

By using this tool, you agree to its terms and that Bay Street Medical will not be liable for any harm relating to your use.

Recommendations provided by this tool do not constitute medical advice and should not be used to diagnose or treat medical conditions.

Full Name (required)

Please enter your full name.

Mother's maiden name

Email Address (required)

Please enter a valid email address.

Phone Number (required)

Please enter a valid 10-digit mobile number.

Date of Birth (required)

Please select your Date of Birth.

Gender (required)

Please select your gender.

Street Address (required)

Please enter a maximum of 35 characters.

Apt, Suite, Building

Please enter an Apt, Suite, Building.

National Insurance Number

Occupation

Place of employment

Country/Region

Upload (NIB / Drivers License / Passport) (required)

Please upload your photo identification.

Select all that apply.

Other Symptons (required)

Please enter other symptoms.

Other Comorbid Conditions (required)

Please enter other comorbid conditions.

Where was you most recent travel? (required)

Please fill the above mandatory field.

Date of most recent tracel (required)

Please select most recent date of travel.

Completed {{ completedDate | date: "MMMM d, y, h:mm a" }}

ID	Patient Name	Email Address	Phone Number	Share Details	Progress	Date Created	Actions

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