Lifeform Chairs COVID 19  SCREENER

Thank you for your interest in getting a LIFEFORM Chair. We’re here to help you find the perfect chair.
For the safety and protection of our community and in accordance with AHS, please complete the following screener before attending your appointment. We appreciate your cooperation.

The following checklist applies for all customers, as well as all who
will be joining you,

The wearing of face coverings or masks is required.

By completing and submitting this declaration you agree to the statements within: * Required

    Have you traveled outside Canada in the last 14 days or had close contact with a case of COVID-19 in the last 14 days?


    YesNO

    Do you have any new-onset (or worsening) of the following core symptoms (unrelated to pre-existing conditions):


    Fever: (required) No

    Cough: (required) No

    Shortness of breath: (required) No

    Loss of sense of smell or taste: (required)No