I am a (required)
PatientCarer accompanying patientProfessional VisitorDigestive Health Staff
Approximate Length of stay (required)
less than 15 minutes30 minutes1 hour3 hoursmore than 3 hours
Phone number (required)
Do you have any of the following symptoms Cough, Sore throat, Shortness of breath, Chills, Recent loss of sense of smell or taste, any other respiratory symptoms?
If Yes, please list your symptoms here:
Are you currently required to self-isolate or quarantine, or awaiting a COVID-19 test result (except if you are part of a surveillance program)?
The Digestive Health Centre will store this information securely to support attestation and for COVID-19 contact tracing. Your information will not be used or disclosed for any other purpose, unless required by or authorised under law to do so.