* Practitioner:
* Patient Name:
* Email Address:
* Phone Number:
* Date of Appointment:
* Date:
* Have you traveled outside of Canada in the last 14 days?
* Are you experiencing any of the following: difficulty breathing, chest pain, having a very hard time waking up, feeling confused, or losing consciousness?
* Are you experiencing any of the following: mild to moderate shortness of breath, inability to lie down because of difficulty breathing, or chronic health conditions that you are having difficulty managing because of difficulty breathing?
* Are you experiencing any of the following symptoms: fever, chills, cough, shortness of breath, sore throat and painful swallowing, stuffy or runny nose, loss of sense of smell, headache, muscle aches, fatigue or loss of appetite?
* Did you provide care or have close contact with a person with confirmed COVID-19 or pending a test?
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What We Are Doing For Your Safety During COVID-19

  • All patients will be screened using the BC COVID-19 Self-Assessment Tool prior to attending their appointment at the Vancouver Island Naturopathic Clinic Inc or with any of the other Private Practices offering services with-in our clinic.
  • All patients will remain in their cars until they are invited into the clinic for their appointment or for their scheduled pick-up.
  • Clinic staff and practitioners will complete daily screenings for symptoms of COVID-19 prior to providing services at the clinic and will not provide services if have signs of illness.
  • All practitioners will be wearing protective equipment as recommended by their regulating colleges and BC Public Health.
  • All practitioners will wash their hands following proper hand washing guidelines before and after all in-clinic patient appointments and multiple times a day.
  • Practitioners will sanitize all areas of patient contact in rooms after each in-clinic patient appointment.
  • We have increased our sanitization frequency and are following the recommend Public Health guidelines.
  • Patient in-clinic appointments will be reduced to allow sanitization between consultations; we will also continue to offer Telehealth appointments.
  • The clinic flow has been modified and visually marked to guide patient traffic and to ensure physical distancing of 2m in the waiting room and common areas.
  • Reception staff will provide customer service from behind plexiglass for staff and public safety.


What We Ask You To Do For Our Clinic and Patient Safety During COVID-19

  • Please do not come to the clinic at any time if you have any of the symptoms associated with COVID-19.
  • If you have an in-clinic appointment or are picking up dispensary items you must first complete the BC COVID-19 Self-Assessment within 24 hours of your appointment with our reception to ensure that you are symptom free. If you have any symptoms associated with COVID-19 we will modify your appointment to a Telehealth consultation when appropriate or reschedule your appointment 10 days from the day of your original appointment. We will also refer you to call 8-1-1 or your medical doctor for assessment, testing and care.
  • We ask that you wash your hands and wear your own mask to your appointment if you have one (this help us preserve personal protective equipment).
  • Please attend the visit alone. We require that only you the patient attend the visit with the exception of parents accompanying children or a caregiver providing support.
  • Please use the washroom prior to your arrival to minimize use of building washrooms.
  • We ask that you remain in your car when you arrive for an appointment or dispensary pick-up and call reception at (250) 881-1806 to check-in. You will be called up when it is your turn. Please do not come into the clinic until we invite you to ensure social distancing.
  • Upon arrival to the clinic we will provide you with hand sanitizer to wash your hands and screen you again for COVID-19. If you do not have a mask and require one, we will provide one for you.
  • All appointments will be invoiced with contact less payment, over the phone or by e-transfer. Please do not bring cash or a cheque.


Novel Coronavirus Information: 1-833-784-4397
Health Information Line: 8-1-1
BCCDC Coronavirus
Island Health