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Covid Medical Questionnaire

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Covid Medical Questionnaire

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Please answer the following questions to help us assess your risk of Covid-19

Email*

Full Name*

Date of Birth*

Select date

Gender*

Ethnicity*

Occupation*

Description:Use this Covid Medical Questionnaire template to screen your patients for Covid-19 symptoms before their appointment. This customizable form can be edited to fit your specific needs.

Screen your patients for Covid-19 symptoms with this customizable Covid Medical Questionnaire template. By using this form, you can ensure the safety of your staff and other patients. The form can be edited to include questions that are specific to your practice. You can also add your logo and branding to make the form look professional. The form is easy to fill out and can be completed by patients before their appointment. By using this form, you can help prevent the spread of Covid-19 and keep your practice safe.

First Name*

Last Name*

Phone Number*

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Last Name*

Phone Number*

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