I am presently not subject to mandatory quarantine and I have not tested positive for COVID-19 in the last 14 days
I have experienced no symptoms of COVID-19 infection in the last 14 days
In the last 14 days I have had no close contacts with persons who tested positive for COVID-19 or suspected to be COVID-19 positive or awaiting for COVID-19 swab test results.
I am aware that I must inform staff if I have been in areas with particularly high rates of COVID-19 infection, or if I have been in contact with relatives or friends arriving from these areas in the last 14 days.
I currently have/do not have the following suspect symptoms for COVID-19:
Fever > 37.5°
Dyspnea (shortness of breath)
Persistent dry cough
Partial or total loss of smell
To speed up the entry procedures as you arrive at the Center on the day of your test/consult, and also to ensure compliance with the social distancing measures, we kindly ask you bring your self-statement form with you, already completed and signed.
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