Talk Stars
Speech and Language Therapy
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COVID 19 Screening
Covid 19 Screening for Direct Therapy Session
*
Indicates required field
Name
*
First
Last
Name of Student
*
In the last 14 days, has anyone in your household travelled outside of Canada?
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YES
NO
Has anyone in your household tested positive for COVID 19, or had close contact with a confirmed case without appropriate PPE?
*
YES
NO
Do you or your student have any ONE of the following symptoms?
*
YES
NO
Submit