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COVID-19 PRE-TREATMENT QUESTIONNAIRE

Do you currently have COVID-19 or any symptoms of COVID-19? *
Have you had COVID-19? *
Does anyone in your household have COVID-19 or symptoms of COVID-19? *
Have you been in close contact with anyone else in the past 14 days who has symptoms of COVID-19
Are you classed as an extremely vulnerable person (high risk)? *
Are you classed as a vulnerable person (moderate risk)? *
Do you agree to adhere to the guidelines in our COVID-19 Policy? *

Thanks for submitting!