Covid-19 Health Questionnaire
COVID-19 screening questions to be answered accurately prior to your appointment. If you have any of the symptoms, however mild, you should stay at home and reschedule your appointment.
Email address *
Full Name *
Contact Number *
Have you had the recent on set of a new continuous cough? *
Do you have a high temperature? *
Have you noticed a loss of or change in normal sense of taste or smell? *
To your knowledge have you been exposed to anyone with Covid-19 in the past 14 days? *
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