Covid-19 Triage Screening Questionnaire
Have you had a high
temperature fever in the last 7 days?
Do you now, or have you recently had, a persistent dry cough or worsening of a pre-existing cough?
In last 14 days have you been in contact with anyone who has
19 or has coronavirus
Have you been told to stay home, self
isolate or self
Do you have loss of taste and smell, unusual fatigue or shortness of breath?
I AM NOT A PERSON CONSIDERED IN A HIGH RISK CATERGORY FOR COVID-19 (E.G DIABETIC/PREGNANT/ OVER 70
I understand that, because my treatment may involve close contact with my practitioner, there may be an elevated risk of disease transmission, including Covid.
I consent to treatment from Jacina Coyne.