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COVID-19 FORM

Prior to attending our office, please complete the following questions regarding any possible exposure to COVID-19.

If you answer “‘Yes’ to any of the following questions, you cannot attend our office and we will contact you to arrange an alternative.

Within the last 14 days, have you experienced a cough that you cannot attribute to another health condition? *

Within the last 14 days, have you experienced shortness of breath that you cannot attribute to another health condition? *

Within the last 14 days, have you experienced muscle aches or soreness that you cannot attribute to another health condition or physical activity? *

Within the last 14 days, have you had a high temperature or fever? *

Within the last 14 days, have you had close contact with anyone who has had or is suspected to have COVID-19? *

When attending our office, please note the following:

  • please maintain social distancing at all times;

  • you will have your temperature taken on arrival;

  • use the hand sanitiser provided at reception;

  • wear a face covering when unable to socially distance during your appointment;

  • limited refreshments will be offered; and

  • practice good hygiene at all times.

Before attending an appointment, please download and read our Covid Appointment Information PDF

Nevett Ford Melbourne Pty Ltd

ABN: 144 697 790

Level 16, South Tower, Rialto Building, 525 Collins Street
Melbourne, VIC 3000