COVID Screening Questionnaire for New Patients

Have you suffered any symptoms of Covid 19 in the past 10 days including (a new cough, a high temperature, loss of taste of smell, or sore throat)? *

Has anyone in your household been diagnosed with Covid 19 or had Covid 19 symptoms in the past 10 days? *

Have you been in close contact with anyone else with Covid 19, in the past 10 days? *

If your physiotherapist is contacted by test and trace, do you consent to your details being given as a contact? *

Have you recently travelled back from a country that requires you to quarantine or take COVID test? *