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587 341 4333
Covid-19 Declaration
How are you feeling today?
First Name
Last Name
Government Identificaton or Alberta Health Card Number
I have not travelled outside of canada within the past 14 days
My body temperature is lower than 98.6°F/ 37.5°C
I am not experiencing the symptoms: fever, cough, sore throat
I haven’t been in close contact with a Covid-19 patient in the last 14 days
I have not been diagnosed with Covid-19
Your Signature
Clear
Date
I declare that the information I’ve provided is accurate & complete
Submit
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