Covid-19 Triage Form

Please complete the below form 24 hours before attending the clinic for treatment or exercise class.


    Do you have a confirmed diagnosis of Covid-19?


    Are you awaiting a Covid-19 test result?


    Have you travelled to any destination on the designated states requiring quarantine (full list here https://www.gov.ie/en/publication/b4020-travelling-to-ireland-during-the-covid-19-pandemic/), or had close contact with someone who has returned from one of these destinations in the last 14 days?


    Have you had close contact with someone who has tested positive for Covid-19 in the last 14 days?


    Have you been asked to self-isolate in the last 14 days?


    Have you had any of the following symptoms in the last 14 days?

    Cough

    Sore throat

    Fever/Headache

    Shortness of breath

    Loss of taste

    Loss of smell


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