C19 screening

COVID-19 screening

Please complete the assessment the day before your appointment

Email address (optional)

If you provide an email address, we may send you service messages such as appointment reminders and important updates.

Questions

1. Do you (or anyone in your household or support bubble) have any of the following symptoms?:
A new continuous cough, a high temperature, or a loss or change in smell or taste.
---yesno

2. Do you (or anyone in your household or support bubble) have, or have you had, possible COVID-19 and are still in the isolation period?
---yesno

3. Do you (or anyone in your household or support bubble) have, or have you had, confirmed COVID-19 and are still in the isolation period?
---yesno

4. If you have been notified by NHS Test and Trace that you have been in contact with a person with COVID-19, are you still in the isolation period?
---yesno

5. If you have entered or returned to the UK in the last 14 days, are you required to quarantine or self-isolate?
---yesno

Thank you for your time in answering the questions.