Covid 19 Questionnaire Form

Do you currently have any flu like symptoms (i.e cough, runny nose, fever, sore throat) or shortness of breath? *
Have you been unwell in the last 14 days? *
In the past 14 days, have you visited any of the COVID19 hotspots? If unsure, please check at *
Are you in close contact or living with any persons who have either recently come back from COVID19 hotspots or have been ill in the last 14 days? *
Have you been in close contact with a person with confirmed COVID19 in the last 14 days? *
Have you been tested for COVID19? (Please note your appointment may be cancelled/rescheduled if you do not have a test result within 48hours prior to the appointment) *
If you have been tested for COVID19, do you have the results? *
If you have received the results, is it: *