Self-Assessment for COVID-19
Semiahmoo Speech Services Inc.
This questionnaire must be completed prior to the first visit to Semiahmoo Speech Services Inc. It must be electronically signed by the adult/parent before the first session. It needs to be completed one time only; however this assessment will be referred to before each session as the clinician has the right to ask you any of the questions below prior to beginning a session.
You need to complete this assessment for yourself and on behalf of someone else (if your child is attending the clinic).
Older people and people with a weakened immune system or underlying medical conditions are considered at higher risk of severe disease are recommended not to attend in-office sessions.
Note that this self-assessment tool is intended for COVID-19 only. Your symptoms may not be related to COVID-19 and could require you to seek medical attention. If you are uncertain and/or feel very sick, contact your family doctor/nurse practitioner or call 8-1-1.