Pre-treatment Covid Triage Questionnaire

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete BEFORE EVERY appointment

Email *

We are very aware of the important role that both our team and patients have in keeping each other and our clinic safe. The health and safety of our patients, staff and visitors to WelwynGarden Osteopaths is essential. You have booked a Face to Face consultation with yourOsteopath but you can change your mind and opt for an on-line telehealth consultation at any time before your scheduled appointment.

Have you had close contact with or cared for someone diagnosed with COVID-19 or suffering from the symptoms of Coronavirus 2, within the last 10 days? *

yes

Have you experienced any cold or flu-like symptoms in the last 10 days (to include fever/temperature more than 37.8°, new continuous cough, sore throat , breathlessness, loss of taste/smell) *

YES

If you answer YES to any of the above, call yourOsteopath on 01707 334902 for advice. DO NOT attend your appointment

Are you clinically vulnerable, or have you or someone in your household been sent a letter from the NHS advising you to shield? *

YES

If you answer YES to the above, call yourOsteopath on 01707 334902 for advice and to alert us but you can still attend your appointment.

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms