COVID 19 Screening

Talk Stars
Speech and Language Therapy

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? *

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