Online Pre-screening – COVID-19

  • Personal details

  • COVID-19 Patient Screen Form

  • * A new, continuous cough means coughing for longer than an hour, or three or more coughing episodes in 24 hours. If the patient usually has a cough, it may be worse than usual.

  • Signature COVID-19
  • Date Format: DD slash MM slash YYYY
  • This field is for validation purposes and should be left unchanged.