Covid-19 Screening Questionnaire

1.  Are you in the high risk category for Covid-19? Do you have extreme respiratory issues (such as severe asthma/ chronic obstructive airway disease), heart disease, immunosuppressed, cancer – especially if currently receiving treatment.

2. Are you pregnant?

3. Have you knowingly had Covid-19? Testing/ severity etc.

4. Have you had any symptoms of Covid-19 over the last 14 days, including new persistent cough, high temperature, fever, sore throat, change or loss of smell, Covid toes, general aches and pains or difficulty breathing, diarrohea, vomiting or abdominal pain?

5. Have you been in contact or cared for anyone who has had symptoms of Covid-19 in the last 14 days?

6. Have you been observing U.K quarantine procedures since 23rdMarch 2020?

7. Have you been working at home or in work surroundings? If the later what precautions have been put in place?

8. Have you been in hospital for in last 14 days? If so what was the nature of your visit and the extent of social distancing?

9. Have you travelled in the last 14 days?  

10. Do you have any concerns about visiting the practice? Would an online consultation suit you better at this time?