Are you / is your child a resident of Marathon, Biigtigong Nishnaabeg or Netmizaaggamig Nishnaabeg? Yes
Is this your / your child’s first or second dose of the COVID-19 vaccine? This is my first dose of the COVID-19 vaccine.This is my second dose of the COVID-19 vaccine.
Your name / child’s name:
Your phone number / child’s phone number:
Your date of birth / child’s date of birth:
Screening Questions I am currently experiencing cough, fever, shortness of breath or decrease or loss of taste or smellI am currently experiencing a runny nose/nasal congestion, headache, extreme fatigue, sore throat, muscles aches/joint pain, gastrointestinal symptoms (vomiting or diarrhea)In the last 10 days, I have tested positive for COVID-19 (rapid or PCR test)In the last 10 days, I have been in close contact with someone with symptoms or who has tested positive for COVID-19 (on a rapid antigen test or PCR test)I have traveled outside of Canada in the last 14 days and have been advised to quarantine by the federal government.
I would like to schedule an appointment on Friday, January 21st Yes
The following appointment time would work best for me / my child: 2:30 to 3:30pm3:30 to 4:30pm4:30pm to 5:30pm5:30pm to 6:30pm6:30pm to 7:30pm7:30pm to 8:00pm
Thank you for requesting an appointment, someone from our team will contact you via email within 24-hours.
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