Corona Virus Pre Appointment Wimb

To prevent the spread of Novel Coronavirus (COVID19) we are initiating the completion of the following self-declaration form to implement necessary outbreak precautionary measures. If you have answered "YES" to any of the 3 travel and contact questions a member of our team will be in contact shortly, we may have to postpone your appointment.
Name & Surname of patient booked in for an appointment*
NameSurname
Email*
example@example.com
Phone Number
Area CodePhone Number
If you are suffering from a cough, fever or shortness of breath please do not visit the practice, stay at home and call NHS 111 for expert advice. Please contact the practice to re-arrange your appointment
Please click on the submit button to complete the process
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