+44 (0)1268 833680 enquiries@facemed.co.uk
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Parent/Guardian/Chaperone Pre-Appointment Triage Questionnaire
- COVID-19 Pandemic

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Please fill out the form below

    • Fever
    • Shortness of Breath
    • Loss of Sense of Taste or Smell
    • Dry Cough
    • Runny Nose
    • Sore Throat
  • Initials
  • DD slash MM slash YYYY
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Telephone:

01268 833680

Email:

enquiries@facemed.co.uk

Address:

FACEmed Cosmetic Medical & Dental Centre
Crays Hill
Billericay
Essex
CM11 2XP

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