Testing For COVID 19 – Crown Mutual Group

Name *

First

Last

Please indicate how you would like to be notified of your results?

Text Message
Email

Phone *

Email *

You will be promted to recieve your test results via email or txt.

What is your age?

Selected Value: 19

You must be 19 years or older to book a COVID 19 test.

Do you require a private test? *

NO
YES

We will follow up with specific instructions.

Our private bookings keep your testing process discrete and secure. Please speak to our representative about any special requirements you may wish to arrange for your test.If you are representing a group or a company please indicate to our staff so we can facilitate accordingly and present you with a preferred rate for testing.

When do you need your test results?

Date

Time

Depending on the test you require please indicate the date you are travelling or when are required to submit a test result.

Are you experiencing any of the following: Severe difficulty breathing (e.g. struggling to breathe or speaking in single words) • Severe chest pain • Having a very hard time waking up • Feeling confused • Losing consciousness *

NO
YES

Please call 9-1-1 or go directly to your nearest emergency department.

These symptoms require emergency medical care. You should call 9-1-1 immediately, or go directly to your nearest emergency department.

Serious symptoms: difficulty breathing or shortness of breath, chest pain or pressure, loss of speech or movement

Select the symptoms you have. If you are not experiencing any symptoms, select "None of the above." *

Are these symptoms unusual for you AND have they lasted more than 24hrs? *

NO
YES

If you have a severe headache or any symptoms that started suddenly, call 9-1-1 or other emergency services now.

Most common symptoms: fever, dry cough, tiredness

Have you received a new COVID-19 test result? (Optional) If you have not entered it here before, please enter the details of your last COVID-19 test. *

NO
YES

IF YES, Please enter the details of your COVID-19 test:

Date

Time

Result of your test

If YES you did have a test please indicate the result.

Have you returned to Canada from any country (including the United States) within the last 14 days? *

NO
YES

September 7, 2021: Border changes

Effective September 7, foreign nationals who qualify for the fully vaccinated traveller exemption can enter Canada for discretionary travel.

Check if you qualify for the exemption

Did you have close contact with a person with confirmed COVID-19 within the last 14 days? *

NO
YES

A close contact is defined as being near a person with COVID-19 for at least 15 minutes when health and safety measures were not in place or were insufficient. Health and safety measures include things such as physical barriers or the physical distancing of at least 2 metres. Note: This means you would have been contacted by your health authority’s public health team.

What is the reason for your COVID test? *

I need it for travel
I need it for work
I have COVID symptoms
Other