* Practitioner:
* Patient Name:
* Email Address:
* Phone Number:
* Date of Appointment:
* Date:
* Have you travelled on a plane or outside of Canada in the last 14 days?
* Are you experiencing difficulty breathing, chest pain, difficulty waking up, feeling confused or dizzy, losing consciousness or discolouration of fingers and toes?
* Are you experiencing 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 fever, chills, cough, shortness of breath, sore throat and painful swallowing, diarrhea, 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