COVID-19 Pre-screening Questionnaire
Dear Patient, it has become mandatory that we implement a pre-screening questionnaire prior to your consultation. This has been advised by the Health Professions Counsel of South Africa.  Please adhere to all protocols: social distancing, wearing of a mask and regularly washing your hands
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Adresse e-mail *
Name and Surname *
Which Practioner do you have an appointment with?
1. Have you tested positive for COVID-19? *
2. If you have tested positive for COVID-19, have you been cleared by a Doctor? *
3.    Have you been in contact with a suspected or confirmed COVID-19 contact within the last 10 days (for more than 15 minutes within a 1m distance)? *
4. Do you have a fever or have you experienced a fever within the last 4 days? *
5. Have you experienced a recent onset of respiratory problems, such as coughing,or difficulty in breathing within the past 14 days? *
6. Have you recently participated in any gatherings, meetings or had any contact with many unacquainted people? *
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