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Mississauga Medical Arts

Medical Clinic and Wellness

Physicians and Allied Health

 

covid 19 outbreak

COVID-19 SHOT CONSENT

Please be prepared to answer the following questions as it may prevent you from getting the shot.

1- Allergies - Please note if you are allergic to PEG (polyethylene glycol or tromethamine), you cannot get the Moderna or Pfizer vaccine.

2 - Have you recieved a vaccine in the past 14 days. (please book after 14 days from your last immunization)

3 - Are you on cancer medications or medications that affect your immune system - please discuss with your doctor prior to booking an appointment.

4 - If you are pregnant or breast feeding, please discuss with your doctor prior to booking an appointment.

 

 

COVID SCREENING

  • TRAVELLED IN THE LAST 14 days
  • Exposed to Covid-19
  • Awaiting Covid-19 test results
  • New onset of cough
  • Worsening chronic cough
  • Shortness of breath
  • Difficulty breathing
  • Sore throat
  • Difficulty swallowing
  • New or unusual worsening of chronic conditions
  • Low blood pressure for your age

 

  • Decrease or loss of sense of taste or smell
  • Unexplained fatigue/lethargy/malaise/muscle aches (myalgias)
  • Nausea/vomiting, diarrhea, abdominal pain
  • Pink eye (conjunctivitis)
  • Runny nose or nasal congestion without other known cause
  • Fast heart rate
  • For infants and young children: decreased or lack of appetite/difficulty feeding

 

PRIOR TO GETTING THE COVID-19 SHOT PLEASE CONSIDER THE FOLLOWING:

We are trying to protect your friends and family.  Please do not come to the clinic if you have symptoms of COVID-19.

 

 

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