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Visitor health questionnaire

We would be grateful if you could complete this short screening questionnaire in advance of your visit.

 

    Your name (required)
    Your email (required)
    Have you recently received a positive coronavirus test result? (within the past 10 days)
    YesNo

    Have you recently experienced the onset of any of the following symptoms:

    • A new continuous cough
    • A high temperature
    • A loss of, or change in, your normal sense of taste or smell (anosmia)

    YesNo

    Has anyone you live with had symptoms of coronavirus within the past 14 days?
    YesNo
    Have you been contacted by the NHS Test and Trace service and asked to self-isolate in the last 14 days?
    YesNo
    Have you been abroad in the past 14 days and been asked to self-isolate upon your return?
    YesNo
    If you've returned from a trip in the past 14 days, please state where from?

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