New Patient Registration Form | 1 Meticulous Podiatrist Chiropodist Cambridge

Are you New or Existing Patient (please select) *

Title *

Name *

First

Last

Date of Birth *

Contact telephone number *

Email *

Email

Confirm Email

Which days suit you best? Please select more than one. *

Please advise what time suits you best. (Example: between 9am and 12pm) *

Short description of your problem *

Let us know if you have foot pain, fungal nail infection, ingrown toenail, hard skin, corns, etc.

Do you or anyone in your household have any symptoms associated with COVID-19 *

Yes
No

The main symptoms of coronavirus are: 1) a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature) a new, 2) continuous cough – this means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual) 3) a loss or change to your sense of smell or taste – this means you've noticed you cannot smell or taste anything, or things smell or taste different to normal

Have you or anyone in your household had contact with anyone confirmed or suspected of having COVID-19? *

Yes
No

Have you or anyone in your household travelled outside the UK in the last 2 weeks? *

Yes
No

Triage For a Podiatry Treatment During COVID-19 Pandemic

All fields are mandatory.