Note: Personal information is being collected by Kemptville District Hospital for COVID-19 screening purposes.
Required fields are indicated with an asterisk (*)
First Name *
Last Name *
Email Address *
Date of Birth *
Have you travelled outside of Canada in the last 14 days? * ---YesNo
In the last 10 days, have you been diagnosed with COVID-19? * ---YesNo
In the last 10 days, have you had close contact with a confirmed case of COVID-19? * ---YesNo
Do you have any of the following potential signs or symptoms of COVID-19:
Fever or chills? * ---YesNo
New cough, worsening chronic cough, shortness of breath or difficulty breathing? * ---YesNo
Decrease or loss of smell or taste? * ---YesNo
Unexplained fatigue/malaise/muscle aches (myalgia) or lethargy? * ---YesNo
Nausea, vomiting, diarrhea or abdominal pain? * ---YesNo
Have you recently been diagnosed with pneumonia? * ---YesNo
Have you been diagnosed with unexplained tachycardia, decreased blood pressure or hypoxia? * ---YesNo
Are you having a Colonoscopy or gastroscopy procedure? * ---YesNo
Are you fully vaccinated with a Health Canada approved vaccine? (fully vaccinated: two doses of Health Canada approved vaccine greater than 14 days ago; approved vaccines: Pfizer, Moderna, Astra Zeneca, Johnson & Johnson) * ---YesNo
Please check this box to acknowledge that you have read this information.
North Grenville COVID-19 Assessment Centre transitioning to DIY Collection Centre
An open letter to the community from your healthcare workers
KDH names Jennifer Ellis as its new VP Nursing/Clinical Services & Chief Nursing Executive
KDH reopens Emergency Department in collaboration with local hospital partners
KDH working to restore systems following cybersecurity incident
KDH temporarily closes Emergency Department due to I.T. disruption
KDH is currently experiencing an I.T. disruption
KDH introduces mandatory COVID-19 vaccination for visitors
Electric vehicle charging stations installed at KDH courtesy of Tesla Canada
New Ontario Health Team Approved
Forgot your password?
Lost your password? Please enter your email address. You will receive mail with link to set new password.
Back to login