COVID Pre-Appointment Screening

SECTION 1

1. Have any of your household been unwell or noticed any of the following symptoms in the last two weeks: Loss or changes in sense of smell or taste, fever, chills or sweats, cough, sore throat, shortness of breath, runny nose?
   

2. Are any members of your household waiting the results of a COVID test?
   

3. Have any members of your household been in contact with COVID positive cases but not been tested yet?

IF YOU HAVE ANSWERED YES TO ANY OF SECTION 1, PLEASE DO NOT ATTEND OUR CLINIC.

SECTION 2

1. Would attending our clinic avoid the need for an appointment/review with a specialist?
   

2. Would attending our clinic avoid an increase in care needs and/or alternate accommodation?
   

3. Would attending our clinic avoid a hospital admission or emergency department presentation?
   

4. Would not receiving care likely lead to a significant deterioration in the health or wellbeing of the patient or other household members?
   

5. Is your infant/child experiencing excessive crying or sleeping issues?
   

6. Are you concerned about the weight gain of your infant/child?
   

7. Are you experiencing feeding difficulty with your infant/child?
   

8. Are you concerned about developmental delays of your infant/child?
   

9. Are you concerned about the shape of your infant/child’s head?
   

10. Are you concerned about your child’s hip joint?
    

11. Are you feeling that your or other members of your household’s mental health is being impacted by your infant/child?

    IF YOU HAVE ANSWERED YES TO ANY OF SECTION 2, YOU ARE ALLOWED TO ATTEND OUR CLINIC.