The purpose of this form is to minimize the risk of potential infectivity regarding COVID-19. This form is required to fill in one day prior to the scheduled appointment.
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1. Have you had a cough in the last two weeks? *
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2. Have you had a temperature in the last two weeks? *
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3. Have you had any unusual symptoms for last weeks? *
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4. Have you been in contact with anyone with COVID-19? *
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5. Have you been visiting any countries where COVID-19 is endemic in the last 2 weeks? *
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6. Have you had a SARS-CoV-2 antigen test? What was the result? (It is required to do this test one day prior to the scheduled appointment) *
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