Did the person hove close contact with anyone with acute respiratory illness or travelled outside Ontario in the last 14 days? *

Does the person have a confirmed case of Covid-19 or had contact with a confirmed case of COVID-19? *

Did you receive your final Covid-19 vaccination more than 14 days ago? *

Does the person have any of the following symptoms? *

If the person is 70 years or older are they experiencing any of the following symptom: delirium, unexplained or increased number of falls, acute functional decline, or worsening of chronic conditions? *