| PRE-APPOINTMENT | IN-OFFICE |
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Do you/they have fever or have you/they felt hot or feverish recently (14-21 days)? | | |
Are you/they having shortness of breath or other difficulties breathing? | | |
Do you/they have a cough? | | |
Any other flu-like symptoms, such as gastrointestinal upset. headache or fatigue? | | |
Have you/they experienced recent loss of taste or smell? | | |
Are you/they in contact with any confirmed COVID-19 positive patients? Patients who are well but who have a sick family member at home with COVID-19 should consider postponing elective treatment | | |
Is your/their age over 60? | | |
Do you/they have heart disease, lung disease. kidney disease, diabetes or any auto-immune disorders? | | |
Have you/they traveled in the past 14 days to any regions affected by COVJO-19? (as relevant to your location) | | |