24hr COVID-19 Triage form 24hr COVID-19 Triage Name* First Last Email* Phone*Do you have a temperature of more than 37.8°C? Yes No Duration (how many hours/days): Do you have a cough? Yes No With sputum? Yes No Duration (how many hours/days): Do you have shortness of breath? Yes No At rest? Yes No On moving? Yes No Duration (how many hours/days): Do you have muscle aches? Yes No Duration (how many hours/days): Do you have headaches? Yes No Duration (how many hours/days): Do you have abdominal symptoms? Yes No Duration (how many hours/days): Do you have loss of taste/smell? Yes No Duration (how many hours/days): Has any of your household members or close contacts had any of these symptoms within the last 14 days? Yes No Have you returned in the last 14 days from a country which means you should now be quarantining? Yes No Consent I agree to the privacy policy.CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
