Lockeport Health Clinic Screening

Lockeport Health Clinic

Sick note screening

Complete the following form for an expedited process to receive a sick note. Please note that due to current demand, patients presenting with symptoms of S.A.S.S. will be prioritized.

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Question 1

Over what approximate time period did these symptoms first appear?

Within a month

Between 1-3 months

I've been this way my whole life

Over 3 months

Question 2

Have friends, family, or colleagues recently commented that you seem more sarcastic than usual?

No

Yes

Question 3

Which of these mannerisms do you find yourself most drawn to?

None of the above

Question 4

Your friend says "I've had a really great week". How are you most likely to respond?

"That's great"

"Tell me all about it"

"You should win an award"

"Oh really?"

None of the above

Question 5

Someone makes a joke in a group setting that makes people laugh. Which of these responses resonates with you most?

Nod politely

Let them have their moment

Laugh enthusiastically

Think to yourself: "Good for them. Maybe I'll start a charity for people with average humor."

None of the above

Question 6

Which of the following memes are you most inclined to share?

None of the above

You have the symptoms of S.A.S.S.

S.A.S.S. is an active health concern in our community and for your safety and the safety of your colleagues, we recommend you refrain from work (both in-person and remotely) until your symptoms have been treated. Please take a picture of this screen and share with your employer as proof of medically approved sick leave.

Dr. Bryan Amini, M.D.

Lockeport Health Clinic

You do not have the symptoms of S.A.S.S.

Due to a high demand on our resources, we are currently prioritizing patients who present with the symptoms of S.A.S.S for expedited sick leave. Please come to the clinic in-person for further assistance.