COVID-19 appointment checklist

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COVID-19

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COVID-19 patient checklist

Protecting patients and staff

All patients visiting the clinic are required to fill in the following form to ensure we maintain a COVID-19 free environment in the clinic for the safety of our patients and staff.

We would like to reassure you that we follow all the precautions recommended by the Royal College of Obstetricians and Gynaecologists and the Ministry of Health regarding infection control. This means that we maintain high levels of hygiene at all times and are taking the following steps to ensure your safety:

  • Continuous sterilisation of surfaces
  • Nurses and clients are required to wear face masks at all times
  • Recommended social distance between patient and staff/medical professionals is enforced
  • The number of clients in the waiting room is kept to a minimum to help maintain social distancing measures. We apologise that only patients are currently allowed in the clinic

    Section 1: High risk categories

    Section 2: Do you or anyone in your household have any of the following?


    Please phone the clinic on 020 7580 8090 to discuss and consider instead booking a remote video/telephone consultation.

    Section 3: Increased risk categories



    You are at increased risk if contract COVID-19 and you should only attend the clinic in person if it is urgent. We will be happy to arrange a telephone or video consultation for you.


    If you come into contact with anyone diagnosed with COVID-19 before your appointment, please call us on 020 7580 8090 to postpone or arrange for a remote consultation.

    Patient declaration

    I hereby declare that the above information is correct to the best of my knowledge at the time of completing this form.