COVID-19 Survey

Dr. Alice Wong and Panda Pediatrics
4825 Dalhousie Drive NW403-239-9333

Symptoms Check

Have you experienced any of the following symptoms in the past 48 hours:

  • Fever or chills
  • cough
  • shortness of breath
  • difficulty breathing
  • fatigue
  • muscle or body aches
  • headache
  • new loss of taste or smell
  • sore throat
  • congestion or runny nose
  • nausea or vomiting
  • diarrhea


Are you isolating or quarantining because you tested positive for COVID-19 or are worried that you may be sick with COVID-19?

Vaccinated / Recovering

Are you fully vaccinated OR have you recovered from a documented COVID-19 infection in the last 3 months?
To be considered fully vaccinated, you must be ≥2 weeks following receipt of the second dose in a 2-dose series or ≥2 weeks following receipt of one dose of a single-dose vaccine.


Have you been in close physical contact in the last 14 days with anyone who is known to have laboratory-confirmed COVID-19 or anyone who has any symptoms consistent with COVID-19?


Are you currently waiting on the results of a COVID-19 test? IMPORTANT: Answer "NO" if you are waiting on the results of a pre-travel or post-travel COVID-19 test.

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