Covid-19 Triage & Consent Form

Covid questions
Have you tested positive for COVID-19 in the last 7 days?*
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Are you waiting for a COVID-19 test or the results?*
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Do you have a new continuous cough?*
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Do you have partial/total loss of your sense of smell or taste?*
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Have you been notified by NHS test and trace in the last 14 days that you are a contact of a person who has tested positive for covid 19 and you do not live with that person?*
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Do you live with someone who has either tested positive for COVID-19 or had symptoms of COVID-19 in the last 14 days?*
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Are you currently Shielding due to being over 70 or have been identified as extremely vulnerable?*
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Do you have a high temperature (over 37.8) *
Please provide details:-
I am are aware that the current Covid 19 pandemic brings a number of known and unknown risks. If I choose to seek dental treatment during the pandemic, it is with the knowledge that there might be an increased risk of Covid 19 to both the dental team and myself from each other. I also understand that the dental practice has taken every precaution to ensure my treatment is provided according to strict clinical protocols issued by NHS England.
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