If you suspect that you might have COVID-19, are displaying symptoms, or a close contact of a confirmed case, please complete this screening form before calling the surgery.
If you have difficulty breathing and feel it is a medical emergency, please phone 999 or 112
About the Screening Form
1. This form is for use during working hours Monday to Friday only. Submitting forms outside this time will delay your test referral. Outside these times please phone MIDOC on 1850 302 702 who will refer you for testing. If you submit a form over the weekend it will not be seen until Monday morning.
2. Ensure that you have the correct phone number and please answer all calls on the phone. You will usually first receive an email acknowledgement and then a phone call from a clinician. You may also hear from us via text.
3. When you click ‘submit’ a secure email will be generated and a doctor will review the information and decide on the best course of action for you. Until you hear from us please start self isolating. You will receive a call or email with further information as to what will happen next.
4. Please be patient and bear with us as our phone lines are extremely busy at this time and we are getting through messages as quickly as possible.
* Items marked with a star are mandatory, we must have a contact number so we can phone you if we are unsure of what you require.
We will acknowledge your form and contact you with further information as soon as we can.