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Patient Covid – 19 Check List

Please fill out the form below.


Patient Covid - 19 Check List
You have a Face to Face appointment scheduled. As part of the current Covid - 19 procedures we require you to complete the following screening questions. This is a legal requirement and is to ensure the safety of yourself and our staff. Please check that all your information is correct before submitting
Exceptions to wearing face mask may apply.
Signature of person with parental responsibility / person legally entitled to sign on behalf of a person who lacks capacity