By signing this form, I state that:
In the last 7 days I haven’t had:
- Cough
- Shortness of breath or difficulty breathing T
- emperature over 37.7
- Loss of taste or smell
In the last 14 days I haven’t
- Been in contact with anyone diagnosed with COVID-19
- Been in contact with anyone with COVID-19 symptoms
- Travelled abroad
If any of the above are present, please CANCEL your appointment and self-isolate as per Government guidelines