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1405 Bloor Street East Unit 5, Courtice, Ontario. Canada
Pharmacy (905) 674-1236
Walk-in Clinic (905) 674-1237
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IDA Courtice
Pharmacy Services
Compliance Blister Pack
Free Delivery Medications
Home Care Products
Medication Reviews
Refill Reminder
Specialty Medications
Walk in Clinic
Contact
PRESCRIPTIONS
Home
IDA Courtice
Pharmacy Services
Compliance Blister Pack
Free Delivery Medications
Home Care Products
Medication Reviews
Refill Reminder
Specialty Medications
Walk in Clinic
Contact
PRESCRIPTIONS
Pharmacy in Courtice
Covid Testing Form
Covid Testing Form
Your #1 Pharmacy & Walk-in Clinic in Courtice
Date of travel
Time of departure
First Name (As it appears on your Health Card/Passport)
Last Name (As it appears on your Health Card/Passport)
Email
Phone #
Address (House/Apt #, Street)
City & Postal Code
Date of Birth
Health Card Number including Two letters
Passport Number
Gender
Female
Male
What kind of test are you looking for?
RT PCR
Rapid Antigen
Do you or anyone in your household have any of the following symptoms
Fever
Cough
Shortness of Breath
Difficulty Breathing
Sore Throat
Chills
Nasal Congestion
Runny Nose
Eye Infection/Pink Eye
Loss of Taste
Headaches
Loss of Appetite
Vomiting
Feeling Unwell
None of the Above
Any travel outside Canada in the last 14 days?
Yes
No
Have you been in close contact with a covid positive person in the last 14 days?
Yes
No
Have you been advised by Local Public Health Unit due to exposure of a confirmed case or as part of an outbreak investigation?
Yes
No
Are you over the age of 70 and experiencing any of the following: Delirium, unexplained or increased number of falls, acute functional decline, worsening chronic conditions?
Yes
No
Not Applicable
Have you been advised to get tested for Covid 19 through an exposure notification?
Yes
No
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