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01333 423775
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Banbeath Dental Practice Logo
COVID
screening

COVID-19 screening checklist

Pre-appointment screening for COVID-19.

your name: (required)
contact number: (required)
tick yes or no: (required)
Do you or anyone in your household or support bubble currently have any of the following symptoms of COVID-19?
  • New and continuous cough
  • High temperature (37.8°C or higher)
  • Loss of sense of smell or taste
  • Flu-like symptoms
Yes
No
tick yes or no: (required)
Have you or anyone in your household or support bubble possibly has or have tested positive for COVID-19 in the past 14 days?
Yes
No
tick yes or no: (required)
Have you had a negative test result for COVID-19 in the past 72 hours?
Yes
No
tick yes or no: (required)
Are you waiting on test results for COVID-19?
Yes
No
tick yes or no: (required)
Have you been notified by NHS Test and Trace that you have been in close contact with a person with COVID-19 in the last 14 days and are required to self-isolate?
Yes
No
tick yes or no: (required)
If you have travelled into the UK in the last 14 days, are you required to self-isolate?
Yes
No
tick yes or no: (required)
When attending your appointment, please:
  • Bring a list of any medication you take
  • Attend at the correct given time
  • Wear a face covering
  • Bring minimal belongings
  • Be advised that our toilet facilities are closed
I have read and understood all the above.
Yes
No
tick yes or no: (required)
I give consent for my details to be passed onto the contact tracing team if required.
Yes
No
verification code: (required)
verification image


Banbeath Dental Practice
1 Banbeath Court, Leven, KY8 5GY
01333 423775
Monday - Friday
8.00am - 12.00pm & 1.00pm - 5.00pm
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coronavirus updates
Banbeath Dental Practice is the trading name of Esme Headen Ltd CO No SC474324
Banbeath Dental Practice
1 Banbeath Court, Leven, KY8 5GY
01333 423775
Monday - Friday
8.00am - 12.00pm & 1.00pm - 5.00pm
sitemap  |  how to find us
cookie policy  |  privacy policy
coronavirus updates
Banbeath Dental Practice is the trading name of Esme Headen Ltd CO No SC474324
2021 Banbeath Dental Practice
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2021 Banbeath Dental Practice
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2021 Banbeath Dental Practice
We always respect and protect your privacy while you use our site. Please take a moment to read and review our cookie policy and privacy policy pages.
We always respect and protect your privacy while you use our site. Please take a moment to read and review our cookie policy and privacy policy pages.