If you are unable to download these please email me mailto:firstname.lastname@example.org and I will email them to you.
PRE-APPOINTMENT COVID-19 SCREENING FORM
1. Are you or a member of your household experiencing symptoms of COVID-19?
· New and persistent cough
· Loss of or change taste or smell
2. Have you or a member of your household been tested positive for COVID-19?
3. Are you or any member of your household in the high risk/clinically extremely vulnerable category?
Please be aware that the virus can be contagious for 2-3 days before the onset of symptoms. If you begin symptoms within 2-3 days after your appointment, please notify me immediately so that guidelines can be followed to minimize spread. Thank you.