Pre-Appointment Screening | Dr. Halstrom

604-876-8993

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Dr. Halstrom & The Silencer – Successfully Treating Sleep Apnea and Snoring Since 1994
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Latest News

Sleep apnea comorbidities: An overview

Sleep health – Reprint Courtesy of Resmed. A few weeks ago, we began talking about sleep...

December 10th, 2020

INSURANCE COVERAGE

The Silencer is covered by many extended health insurance plans, among them Pacific Blue Cross...

February 8th, 2020

Pre-Appointment Screening

COVID-19 SCREENING

Name
First Last
Date of Birth:
In the past 14 days have you had any history of fever?*
- Yes
- No
In the past 14 days have you had any new onset of cough or difficulty in breathing?*
- Yes
- No
Have you or any household members traveled outside of Canada in the past 14 days?*
- Yes
- No
Have you or any household members had close contact with a confirmed or probable case of COVID-19?*
- Yes
- No
Have you been tested for COVID-19 in the last 14 days?*
- Yes
- No
If yes to testing - indicate status:
- Unknown
- Negative
- Positive
Are you diabetic or have an auto-immune disease like lupus rheumatoid arthitis,celiac disease, etc?*
- Yes
- No
Any other medical conditions we should be aware of?*
- Yes
- No
Cell Phone Number For Day Of Appointment?
On the day of the appointment we will ask you to wait nearby or in your vehicle - we will call you to the office once we have finished with the previous patient.

About Dr. Halstrom

With a great deal of good fortune I was able to walk away from a serious single car accident. Following the accident I was diagnosed with sleep apnea. I tried CPAP therapy unsuccessfully, as I was unable to accommodate to the daily requirements of wearing the mask....Read More

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