COVID-19 Pre-Assessment Form

Due to the increased volume of phone and email queries about Podiatry Service Provision, we have decided to run Emergency podiatry clinics in-line with criteria announced by the HSE.

We understand our patients are concerned for themselves and their loved ones and we can assure you we are doing everything we can to operate as normally as possible in these extraordinary times, while at the same time minimising the risk of exposure to our patients and families.

Our Emergency Clinics will have strict pre-assessment criteria which will keep us and our families safe. Our usual high standards of de-contamination, sterilisation and general disinfection between patient appointment slots remain in place.

Date of Birth*
Symptom Checker*

Please outline your symptoms below.

Fevers/Chills (fever usually above 38 degrees)Cough (can be dry or productive/chesty)Difficulty Breathing/Shortness of BreathSore throatRunny noseDiarrhoeaVomitingAches & PainsFatigueNo symptoms (if you have no symptoms, you are unlikely to meet the criteria for testing)
Duration of symptoms*

How severe are your symptoms?

Recent Travel/Contact with confirmed Corona virus case*

Have you traveled to an area affected by the Corona virus or been in close contact with a confirmed case of Corona virus - this is not required for Covid-19 testing, however is useful information

YesNo
Are you currently self isolating?*

Anybody with respiratory symptoms of any kind is now advised to self-isolate.

YesNo
Brief outline of your symptoms/concerns*

Please give a brief outline of your symptoms, when they started and your concern re. testing. If you have any other symptoms not covered in the checklist above, please let us know here also.

Next Steps

  • On receipt of the form, one of our Podiatrists will contact you to confirm receipt and clarify any issues via phone consultation if needed.
  • If you are a parent of a patient under 18, you are also required to fill in this form. And only the parent who has filled in this form can attend with the patient
  • The above also pertains to patients who require a carer.
  • If you meet the current pre-assessment criteria and are clear from Covid-19 as outlined by Health Protection Surveillance Centre Guidelines, we will offer you an appointment.
  • We are also offering virtual appointments and treatment plans, if we do not think a facing appointment is appropriate.
  • Please be patient, we are experiencing high demand at present, but we promise to get back in touch as soon as we can.
  • If your symptoms worsen whilst you are awaiting an appointment, please contact us so we can further evaluate.
  • Please do not come in to the practice as you risk passing on infection to other patients and our staff.

 

  • Further information:
    1. Useful information on self-isolation, can be found on the HSE’s information page here.
    2. Useful information on the virus can be found on the HSE Covid-19 page here.
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