Your name(Required)
Date of birth(Required)
What is the date of your hospital prodecure (not covid test)?(Required)
I am able to attend the appointment you have sent(Required)
Have you tested positive for Covid 19 in the past 90 days?(Required)
Do you have a household member who is positive or has covid symptoms?(Required)
Have you travelled from another country in the past 10 days?(Required)