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FAMILY & SPECIALTY MEDICINE & WALK-IN
416-222-6160
2 Champagne Drive: East Entrance
Champagne Centre
Toronto, ON M3J 0K2

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  • Home
  • Walk In Clinic
    • Walk-in Clinic
  • Family Medicine
    • Physicians Accepting New Patients
  • Specialty Medicine
    • Specialty Consultation Areas
    • H. Pylori testing
    • Nerve Conduction Studies
    • FibroScan Testing
    • Balance and Dizziness Testing
  • Services
    • Cardiology Department
    • Laboratory and Physician Assistant Services
    • North York Pulmonary Function Centre
    • North York Sleep & Diagnostic Centre
    • Independent Tenants/Subtenants
  • About Us
    • Our Vision
    • Management Team
    • Our Doctors
    • Clinical Research
    • Photo Gallery
  • Resources
    • For Patients
      • Appointment Reminders
      • Polyclinic Notices
      • Polyclinic Policies
      • Patient Instructions
      • Patient Feedback
    • For Physicians
      • Referral Information
      • Referral Forms
      • Physician Feedback
  • Contact
    • Clinic Directory
    • Map & Directions
    • Hours of Operation
    • Facility Map
    • Join our team

COVID-19 Pre-Screening Questionnaire

Home/COVID-19 Pre-Screening Questionnaire

  • COVID-19 PRE-SCREENING QUESTIONNAIRE

  • Please complete our COVID-19 screening 1 – 2 days before your scheduled in-person appointment

  • To help our health professionals with your assessment and as a precaution to limit the risk of transmitting the COVID-19 virus, it is important we take measures to protect our patients, staff and physicians.
  • MM slash DD slash YYYY
  • Kindly answer the below questions before seeing the physician or having your testing done:
  • MM slash DD slash YYYY

  • b) Did you isolate the greater of;

  • If you answer yes to any of the above questions, do not come into the clinic. Call our office to re-schedule your in-person appointment and call Telehealth Ontario at 1-866-797-0000

  • If you have additional questions, please contact Health Connection, Monday to Friday from 8:30 am to 4:30 pm at 1-800-361-5653. After hours please call Telehealth Ontario at 1-866-797-0000.

    October 8, 2020

  • Date of form submission: 06/18/2025

Polyclinic Family and Specialty Medicine located in North York

Family & Specialty Medicine
Walk-in Clinic
2 Champagne Drive
Champagne Centre
Toronto M3J 0K2

Book an Appointment

416 222 6160

9am-8pm Monday-Friday
Saturday 9am-1pm or by appointment
OR visit our walk-in clinic directly

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