Covid Questionnaire | Hamilton Orthodontics

To view our Covid-19 triaging questions please click here. Please follow our Facebook page for updates on this continually evolving situation.

Triaging Questionnaire

Full Name

Phone

1. Do you or any member of your household have COVID-19 or are you waiting for a COVID-19 PCR test result? (not a routine surveillance test result)? Yes No

2. Are you required to self-isolate (including arrival from overseas)? Yes No

3. Do you have ANY of the following symptoms now, or in the last 14 days?

Fever, acute cough or shortness of breath
Muscle aches, loss of smell, sore throat
Generally feeling unwell with no other likely diagnosis

Yes No

4. Do you have any other reason to think that you are at risk of having COVID-19? Yes No

If you, or the person attending the appointment with you as support person, answers “YES” to any of these questions, please call 07 839 5870 to rebook your appointment.

Looking after you while looking after your smiles

Triaging Questionnaire

Thanks! We’ll see you soon.

As you answered “YES” to one or more of these questions, please call 07 839 5870 to rebook your appointment.