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COVID-19 Triaging Questionnaire

COVID-19 Triaging Questionnaire

  • Date Format: DD slash MM slash YYYY
  • COVID-19 Risk Assessment

  • Medical Health Assessment

    Please tick YES or NO for each medical condition AND write down medication taken if applicable.
  • Please list any medications not already listed including recreational usage
  • Consent

  • Date Format: DD slash MM slash YYYY
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