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Patient Survey


    Patient Details

    Have you recently (14-21 days) experienced the following symptoms PRE-APPOINTMENT
    Fever/High temperature?
    Shortness of breath or Difficulty breathing?
    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?

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