COVID screening questionnaire | TIE

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call us now on: 01622 751553

call us now on 01622 751553

COVID-19 Screening Questionnaire

It is important to establish COVID-19 status before confirming an appointment. If it is essential to be accompanied by a parent, carer, or comforter, then that person should also be screened.

Covid Screening Questionnaire

Full name*
Email address*
1. Do you have any of the following symptoms:*
High temperature or fever, new continuous cough, or a loss or alteration to taste or smell?
- Yes
- No
N.B. Please note, a new, continuous cough means coughing for longer than an hour, or three or more coughing episodes in 24 hours. If you usually have a cough, it may be worse than usual.
2. Have you or any member of your household/family had a confirmed diagnosis of COVID-19 in the last 10 days?*
- Yes
- No
3. Are you or any member of your household/family waiting for a COVID-19/SARS-CoV-2 PCR test result?*
- Yes
- No
4. Have you travelled internationally in the last 10 days to a country that is on the government red list?*
- Yes
- No
5. Have you or any member of your household/family been advised to isolate by any NHS organisation in the last 10 days?*
- Yes
- No

CONTACT INFORMATION:

01622 751553

[email protected]

3 Ashford Road
Maidstone
Kent
ME14 5BJ

Map location of The Implant Experts in Maidstone, Kent

Map location of The Implant Experts in Maidstone, Kent

GENERAL INFORMATION:

Opening hours:
Monday - Friday 08.45 - 17.15

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