COVID-19 Risk Assessment & Triage

Please answer the questions below:-

    1. Have you tested positive for COVID-19 in the last 7 days or been told to self -isolate?
    YesNo
    2. Do you have a runny nose, headache, fatigue (mild or severe), sneezing, sore throat?
    YesNo
    3. Do you have a raised temperature, loss/ change to sense of smell/taste, recently developed any cold/ flu symptoms, a cough, hoarseness, shortness of breath, chest pain/ tightness?
    YesNo
    4. Have you had exposure to a suspected or confirmed case of Covid-19 from someone in your household, co-worker or while socializing (contacted by track and trace)?
    YesNo
    5. Do you feel unwell in any way at all?
    YesNo
    6. I agree to let the chiropractic clinic know as soon as possible if I am experiencing any symptoms of Covid-19 and reschedule my appointment
    YesNo
    7. Are you in the "Clinically Extremely Vulnerable" group identified in Government Guidelines?
    YesNo

    We may need to discuss things further but you may call us if you are unsure in any way.