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Quinte Health Care
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This webform is for use to pre-register for the Community Assessment Centres located in Bancroft, Belleville and Quinte West.  Please book an appointment for the Assessment Centre located in Picton by calling 613-813-6864.  

Complete all required fields in the COVID-19 Community Assessment Centre Pre-registration form in order to submit the form. This form must be completed separately for each person in your family requiring a COVID-19 test.  Within 24 hours you will be provided with instructions and directions for attending a local assessment centre.   

Quinte Health Care has made an exception to allow the use of unencrypted email for the purpose of preregistering during the declared emergency.  In order for QHC to use unencrypted email, we must obtain the consent of the patient for this purpose.  If you do not consent, please pre-register by phone at 613-961-5544.  

Do you consent, understanding that unencrypted email carries an inherent risk of disclosure to third parties, to the use of email for the purpose of sending confirmation of your Preregistration Status for your COVID-19 Assessment Centre visit?”*
What is your preferred Assessment Centre location? *
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Note: Please enter your name as it appears on your health card.
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Birthday*
  
Gender*
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Are you experiencing any symptoms? (Please ensure you have completed the self-assessment and meet the latest provincial guidelines for testing. Visit the COVID-19 page of our website – www.qhc.on.ca for more information.)*
Please select any symptoms you are experiencing.
Are you in any of these at-risk groups?
Were you exposed to an individual with a probable or confirmed case of COVID-19? *
Have you traveled out of Ontario or Canada in the last 14 days? *
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What is your preferred date for testing? *
YOU MUST COMPLETE A SEPARATE FORM FOR EACH PERSON REQUIRING TESTING.