My COVID-19 Check-In

A visit with the doctor to talk about staying healthy and well during the pandemic

Introduction

During a pandemic like COVID-19, a lot changes. Maybe you cannot do your sports anymore, or go to work, or visit friends like you used to. It is good to check in with your doctor about how these changes affect your health. Many people have not seen their doctor in a long time, so it is good to have a check-in. The My COVID Check-In form helps to talk about your health and feel prepared for a check-in with the doctor.

The form lists twelve health topics. You can choose the topics that you find important to talk about. Write down questions and bring the form to the healthcare visit. It will help remember what you want to talk about. You can choose to use a long form, which has a lot of space to write. Or, maybe you want to use a short form that is easy to carry around. A picture form is also available. Finally, there is information for caregivers with tips on how to use My COVID Check-In.

Select the full package for download, or print the forms separately.

Download: My COVID Check-In Full Package

Download: My COVID Check-In Long Form

Download: My COVID Check-In Short Form

Download: My COVID Check-In Picture Form

Download: My COVID Check-In Caregiver Guide

This form is part of a research study. Let us know how you like it!

Leave us your feedback

Supporting materials
About the tool development

Steffi Explains It Clearly

Online information about COVID and other health topics can be difficult to understand. Everybody has a right to clear information. That is why avatar Steffi explains things in a clear and easy to understand way. She does this by using animated pictures, text and audio. Steffi was originally developed in the Netherlands, Europe.

Together with the Centre for Addiction and Mental Health (CAMH, Toronto), we are exploring how Steffi would do her work in Canada. Have a look at her website at steffihelps.ca. Let us know how you like it! You can send us an email at ddpcp@surreyplace.ca.

Books Beyond Words

At Books Beyond Words, from the United Kingdom, you can find helpful word-free picture books about COVID, and the pandemic. Visit the webpage Coping With Coronavirus to find free stories for download.
Self-help Booklets

The pandemic has been a difficult time for all of us. At the Centre for Addiction and Mental Health (CAMH) website you can find Self-help Booklets that can help you think about how you feel. You can read these alone, or together with family or caregivers. There is a how-to guide for caregivers for each booklet too. The booklets can help you stay well at a difficult time.

The My COVID Check-In form is developed by the Developmental Disabilities Primary Care Program (DDPCP) at Surrey Place, Toronto, and the Azrieli Adult Neurodevelopmental Centre, CAMH, Toronto, with support from the Canadian Institutes of Health Research (Operating grant FRN #EG2 179428; Addressing unmet and emerging health needs of Canadian adults with intellectual and developmental disabilities and their families during COVID-19.). This version is part of a research study and under development.

The content of this tool was subject to review by clinicians, primary care providers, families, and self-advocates. This tool is developed as a guide only. Primary care providers and other healthcare professionals are required to exercise their own clinical judgement in using this tool.

Supporting materials
Steffi Explains It Clearly

Online information about COVID and other health topics can be difficult to understand. Everybody has a right to clear information. That is why avatar Steffi explains things in a clear and easy to understand way. She does this by using animated pictures, text and audio. Steffi was originally developed in the Netherlands, Europe.

Together with the Centre for Addiction and Mental Health (CAMH, Toronto), we are exploring how Steffi would do her work in Canada. Have a look at her website at steffihelps.ca. Let us know how you like it! You can send us an email at ddpcp@surreyplace.ca.
- Books Beyond Words
  
  At Books Beyond Words, from the United Kingdom, you can find helpful word-free picture books about COVID, and the pandemic. Visit the webpage Coping With Coronavirus to find free stories for download.
- Self-help Booklets
  
  The pandemic has been a difficult time for all of us. At the Centre for Addiction and Mental Health (CAMH) website you can find Self-help Booklets that can help you think about how you feel. You can read these alone, or together with family or caregivers. There is a how-to guide for caregivers for each booklet too. The booklets can help you stay well at a difficult time.
About the tool development

The My COVID Check-In form is developed by the Developmental Disabilities Primary Care Program (DDPCP) at Surrey Place, Toronto, and the Azrieli Adult Neurodevelopmental Centre, CAMH, Toronto, with support from the Canadian Institutes of Health Research (Operating grant FRN #EG2 179428; Addressing unmet and emerging health needs of Canadian adults with intellectual and developmental disabilities and their families during COVID-19.). This version is part of a research study and under development.

The content of this tool was subject to review by clinicians, primary care providers, families, and self-advocates. This tool is developed as a guide only. Primary care providers and other healthcare professionals are required to exercise their own clinical judgement in using this tool.

All rights reserved. No part of this website may be reproduced, stored in a retrieval system or transmitted in any form or by any means without the prior written permission of the copyright owner, Surrey Place. Contact the Developmental Disabilities Primary Care Program at Surrey Place at ddpcp@surreyplace.ca for permission to adapt information and tools to your local practice setting.

My COVID-19 Check-In

My COVID-19 Check-In

A visit with the doctor to talk about staying healthy and well during the pandemic

Introduction

Related Guidelines

Related Tools

Share

Steffi Explains It Clearly

Steffi Explains It Clearly

Join Us for the DDPCP Forum: Advancing Inclusive Healthcare!