• Here at the OHC we take the health of our patients and staff very seriously. Please take the time to fill in this form prior to your appointment and alert us, as soon as possible, if there have been any changes or onset of symptoms. 

    Thank you

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    Do you have any of the following symptoms?
  • Cough
  • Temperature
  • Loss of taste or smell
  • Shortness of breath
  • Aches and pains - separate to the condition for which you are seeking treatment.
  • Cold like symptoms
  • Tummy upset or nausea
  • Do you agree to inform us immediately if you develop any of the above symptoms?

  • COVID - 19

    Testing, exposure and risk.
  • Have you been in contact with anyone with confirmed COVID 19 in the last 10 days?

  • If you have answered YES to the above question your appointment may be cancelled and rebooked. We will contact you if we need further clarification. 

  • Have you had covid in the last 2 weeks?
  • Is it 10 days since your FIRST positive test?
  • Do you understand that, even with our cleaning, screening and PPE measures in place, there is still a risk of transmission of COVID-19 from attending the clinic?
  • Do you agree to inform us immediately should you develop any of the above mentioned symptoms OR should your general health change?

  • Thank you for taking the time to fill in this form. Click the submit button below and we look forward to seeing you at your appointment. 

    Take care

    The OHC

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