COVID-19 Screening Questionnaire

1. Does patient / member of household have symptoms suggestive of COVID 19?

• A high temperature
• A loss of taste/smell
• A cough

If yes, please phone to discuss this.

2. Are you or anyone in your household ‘shielding’ due to immunosuppression or other health risk?

If yes, please phone to discuss this.

3. Risk benefit analysis.

You should be aware that there is a very small increased risk of contracting COVID-19 inherent in attending the practice/department.

4. Consent: discussion of risks and benefits for the proposed procedure planned for the forthcoming visit.

- You will receive a phone call from a member of staff with more details of how things will be coordinated on the day of your appointment.

- Be aware that there is a higher than usual chance of last- minute cancellation due to current unpredictable circumstances.

Please contact us by email if you have any queries.