8391 Alexandra Rd #2120, Richmond, BC V6X 3W5

(604) 279-0188

8391 Alexandra Rd #2120, Richmond, BC V6X 3W5

(604) 279-0188

COVID 19 Questionnaire

Patient Screening Questionnaire for COVID-19
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Please check the following boxes if any of the conditions apply to you:

1.) Are you experiencing any of the following symptoms?
2.) Check off all of the symptoms you are experiencing right now
3.) Have you returned to Canada from any country (including the United States) within the last 14 days?
4.) Did you have close contact with a person with confirmed COVID-19 within the last 14 days?

A close contact is someone confirmed to have COVID-19 who you live with or otherwise had close face to face contact (within 2 meters) while they had symptoms or in the 48 hours before their symptoms started.

Note: This means you would have been contacted by your health authority’s public health team.

Please do not submit any Protected Health Information (PHI).

Hours

Monday  

9:00 am - 5:30 pm

Tuesday  

9:00 am - 5:30 pm

Wednesday  

9:00 am - 5:30 pm

Thursday  

9:00 am - 5:30 pm

Friday  

9:00 am - 5:30 pm

Saturday  

9:00 am - 5:30 pm

Sunday  

Closed

Visit Our Office

Find Us On The Map!

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Dr. Jennifer Yu Optometry Centre

Address

8391 Alexandra Rd #2120
Richmond, BC V6X 3W5

Contact Information (604) 279-0188

CONTACT US

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Please do not submit any Protected Health Information (PHI).