Calculatorpatient survey
Patient Survey

test

    Patient Details

    Have you recently (14-21 days) experienced the following symptoms PRE-APPOINTMENT
    Fever/High temperature?
    Shortness of breath or Difficulty breathing?
    Cough?
    Flu symptoms i.e headache, runny nose, fatigue?
    Recent loss of taste or smell?
    Do you have Heart disease, Lung disease, Kidney disease, Diabetes or Auto-immune disorders?








    This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.

    0