First name
Last name
SCREENING QUESTIONS
DO YOU HAVE ANY RESPIRATORY OR INFECTIOUS SYMPTOMS? NOYES
HAVE YOU BEEN IN CONTACT WITH ANYONE WHO HAS COVID-19 OR ANYONE AWAITING A COVID-19 RESULT? NOYES
IF YOU ANSWERED YES TO EITHER OF THE ABOVE QUESTIONS, WHY ARE YOU HERE? DO NOT ENTER THE CLINIC! GO TO THE GROUND FLOOR OUTSIDE THE BUILDING AND CALL RECEPTION OR MANAGEMENT IMMEDIATELY!
I confirm that the information in this attestation is true.
