Please complete the form below within 8 hours of visiting the FullMast Men’s Health Clinic.

    Your email (so you have a copy to show the receptionist - if required)

    Do you have any of the following:

    Fever?

    Cough?

    Difficulty breathing?

    Sore throat?

    Runny nose?

    Loss of taste or smell?

    Not feeling well?

    Nausea, vomiting or diarrhea?

    Within the last 14 days have you been in close contact with anyone with COVID-19?

    Within the last 14 days have you travelled outside Canada?