QUESTIONNAIRE FOR CHECKING THE PATIENT'S HEALTH STATUS BEFORE TREATMENT IN THE CLINIC

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All questions also refer to the last 14 days

If you answered YES to any of the questions, FIRST CONSULT your primary physician or healthcare provider BY TELEPHONE before treatment.

Email *

Ime in Priimek *

Do you have a fever (temperature above 37.5 ºC)? *

Yes

Do you have a cold? *

Yes

Do you have a cough? *

Yes

Do you have a sore throat, oesophagus? *

Yes

Are you experiencing changes of taste or smell? *

Yes

Are you experiencing shortness of breath or tightness in your chest? *

Yes

Do you have sore muscles? *

Yes

Do you have digestion problems (diarrhoea or vomiting)? *

Yes

Is anyone at home or work experiencing such problems? *

Yes

Have you tested positive to Covid-19? *

Yes

Have you been in contact with a Covid-19 confirmed patient (sick relatives, roommates)? *

Yes

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A copy of your responses will be emailed to the address you provided.

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