Medix Brampton – No-Symptoms Yes-Vaccinated – Medix College

Medix Brampton
COVID-19 Waiver and Release Form

Based on your response, you are vaccinated and you do not have any symptoms. Please fill out the form to receive instructions.

Vaccination Status

Your First Name (required)

Your Last Name (required)

Your Email (required)

Your Phone Number (required)

Date (required)

Arrival Time (required)

Medix Campus (required)

Reason for Visit (required)

Medical Reason

Completed Covid Vaccination Video

Have You Completed Your Weekly Rapid Test with a Negative Result

Covid Symptoms Screening