covid 19 Questions for patients prior to appointment

Questions for patients prior to appointment
Patient's Name

First NameLast Name
Have you had corona virus
When did you have it?
Did you need to be hospitalised
Are you symptom free now?
Is there anyone in your house who has corona virus?
Are you in a vulnerable category?
Are you shielding at present
Have you been in an airplane in the last two weeks?
Where did you travel to?
The Smile Team, 831A High Road, North Finchley, London N12 8PR T: 020 8445 2994 E: info@thesmileteam.co.uk www.thesmileteam.co.uk
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