Please fill in the form below on the day of the appointment prior to every appointment.
Pre-appointment health screening
- Have you tested positive for COVID-19 in the last 7 days?
- Are you currently waiting for a COVID-19 test or the results to come back?
- Do you currently have any of the following symptoms:
- New, continuous cough?*
- High temperature or fever?*
- Loss of, or change in, sense of smell or taste?*
- Unusually short of breath?
- New abdominal pain or diarrhoea?
- New blocked or runny nose?
- Headache?
- New unusual fatigue or muscle pain?
- Do you live with someone who has either tested positive for COVID-19 or had symptoms of COVID-19 in the last 14 days?
- Have you been notified by the Test and Trace in the last 14 days that you were a contact of a person who has tested positive for COVID-19 (someone you do not live with)?
- Are you or anyone in your household currently self-isolating, shielding or classed in the high risk category? (e.g. severe respiratory condition, pregnant, taking immunosuppressive medication)
- Have you travelled outside of the UK in the last 14 days?
(* Main COVID-19 symptoms)
Please also have a read through to ensure you are not in the high risk or extremely high risk categories to attend a face to face appointment.
| High Risk | Extremely High Risk |
|---|---|
| Aged 70 or older | Have had an organ transplant |
| Are pregnant | Are having chemotherapy or antibody treatment for cancer, including immunotherapy |
| Have a lung condition that’s not classed as severe (such as, but not limited to, asthma, COPD, emphysema or bronchitis | Are having targeted cancer treatments that can affect the immune system (such as protein kinase inhibitors or PARP inhibitors) |
| Have heart disease (such as heart failure) | Have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma) |
| Have diabetes | Have had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine |
| Have chronic kidney disease | Have been told by a doctor they have a severe lung condition (such a, but not limited to, cystic fibrosis, severe asthma or severe COPD) |
| Have liver disease (such as hepatitis) | Have a condition that means they have a very high risk of getting infections (such as, but not limited to, SCID or sickle cell) |
| Have a condition affecting the brain or nerves (such as, but not limited to, Parkinsons disease, motor neurone disease, multiple sclerosis or cerebral palsy) | Are taking medicine that makes them more likely to get infections (such as high doses of steroids) |
| Have a condition that means they have a high risk of getting infections | Have a serious heart condition and are pregnant |
| Are taking medicine that can affect the immune system (such as low doses of steriods) | |
| Are very obese (a BMI of 40 or above) |