COVID-19 Patient Questionnaire - Dental clinic Anja Siegl, dr. dent. med.

Do you have a fever (above 37.5º C)?
YesNo

Do you have a cold?
YesNo

Are you coughing?
YesNo

Do you have a sore throat?
YesNo

Do you have a changed taste or smell?
YesNo

Do you have a feeling of shortness of breath or pressure in your chest?
YesNo

Do you have muscle pain?
YesNo

Does anyone else have such problems at home or at work?
YesNo

Did you have a positive test on Covid-19?
YesNo

Have you been in contact with a COVID-19 confirmed patient (sick relatives, roommates)?
YesNo

Have you been in a country that is on the red list in the last 14 days?
YesNo

Did you get 14-day quarantine in the last 14 days?
YesNo

I state that the above statements are true. If I find that the answer to any of the questions is * Yes *, I will immediately inform the Dental Clinic Anja Siegl and consult about the postponement of the appointment. If I have traveled in other countries in the last 14 days, I also checked that this visited country is not on the red list.(LINK: LIST OF COUNTRIES)