Parkbury House Surgery

St Peters Street, St Albans, Hertfordshire, AL1 3HD

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Tel No: 01727 851589 Email: parkburyhouse.info@nhs.net Out of Hours: 111

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For new concerns, please phone the surgery on 01727 851589, or fill out an eConsult form to contact a doctor
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We welcome new patients to our surgery. You can either register online or visit our surgery during opening times to complete the registration forms.
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- New patient registration form
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We offer a full range of services for all our patients at Parkbury House Surgery.
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Your care at Parkbury House Surgery is provided by an experienced team of dedicated health professionals who work very closely together to provide you with the best possible care.
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Leaflets

Post COVID Screening Tool

Post COVID Screening Tool

Full Name: *

Date of Birth: *

Please use date format DD/MM/YYYY

Phone Number:

Email Address: *

Today's Date:

Have you made a full recovery or are you still troubled by symptoms?

Symptoms persist

Full recovery

Are you more breathless now than you were before your COVID illness?

Yes

No

Is this more than you would have expected by now?

Yes

No

Do you think you are on your way back to full fitness?

Yes

No

Do you feel fatigued (worn out/lacking energy or zest) compared with how you were before your COVID illness?

Yes

No

Is this more than you would have expected by now?

Yes

No

Do you think you are on your way back to full fitness?

Yes

No

Do you have a cough (different from any cough you may have had before COVID19)?

Yes

No

Do you get any palpitations? (sense that you can feel your heart pounding or racing)

Yes

No

How is your physical strength? Do you feel so weak that it still limiting what you can do (more than you were pre your COVID illness)?

Yes

No

Do you have any myalgia (‘aching in your muscles’)?

Yes

No

Do you have anosmia (‘no sense of smell’)?

Yes

No

Have you lost your sense of taste?

Yes

No

Is your sleep disturbed (more than it was pre-COVID)?

Yes

No

Have you had any nightmares or flashbacks?

Yes

No

On your mood, is your mood low/do you feel down in the dumps/lacking in motivation/no pleasure in anything?

Yes

No

Do you find yourself feeling anxious/worrying more than you used to?

Yes

No

Have you lost weight (more than ½ stone, 3 Kg) since your COVID illness?

Yes

No

Any other symptoms (list):

Parkbury House Surgery Online

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