COVID-19 Question Form

Please fill out and submit before your visit at WOWMOMS World Montreal.

COVID-19 Questionnaire

Please submit this form before your visit.

1) Was your temparture taken before your visit?

Yes

No

What was the temperature recorded?

2) Have you taken any medication in the past 24 hours treating a fever or any other illness?

Yes

No

3) Are you exhibiting ANY symptoms relating to COVID-19? (new cough that is getting worse, difficulty breathing, nausea, vomiting, diarrhea, sudden loss of smell or taste without nasal congestion)

Yes

No

4) Is any household member in self-isolation following travel or exhibiting any COVID-19 symptoms?

Yes

No

5) Has public health required you or any member of you family to self-isolate or to pay attention to symptoms?

Yes

No

WOWMOMS World Montreal

5155 Rue De Sorel

Montreal, Qc, H4P 1G7

Tel: 1-855-969-6667

Opening Hours

Monday CLOSED

Tuesday to Friday 9am-5pm

Saturday & Sunday 9am-4pm

What can we help you with?

Thanks for submitting!