COVID-19 SURVEY | COVIDTESTSYDNEY

Do you live in Sydney? *

Yes
No

Are you a medical practitioner? *

Yes
No

Please enter your provider number *

Please enter your practice address *

Are you a healthcare worker, teacher, first responder, or work in an essential service? *

Yes
No

Are you worried that you may have COVID-19? *

Yes
No

Have you received a COVID-19 vaccination? *

Yes
No

Do you have symptoms of COVID-19?
If you have both severe and mild symptoms, select severe.

Severe *

Yes
No

Do you have any of the following?

I have a fever of 40 degrees or higher, OR I have fever that has lasted longer than 48 hours.

I can't speak in full sentences or do simple activities without feeling short of breath.

I am having severe coughing spells, or I am coughing up blood.

My lips or face are blue.

I have severe and constant pain or pressure in my chest.

I feel very tired or lethargic.

I feel dizzy, light headed, or too weak to stand.

I am having slurred speech or seizures.

I do not feel like I can stay at home because I feel seriously Ill.

Mild *

Yes
No

Do you have any of the following?

I have fever between 37.5 degrees and 39.9 degrees, am feeling feverish, or feeling warm to the touch.

I have a new or worsening cough.

I have a new or worsening sore throat.

I am having flu-like symptoms (chills, runny or stuffy nose, body aches, and/ or feeling tired).

I am having mild shortness of breath that is not limiting my ability to speak.

I have diarrhoea.

I am recently experiencing headache.

I have lost my sense of taste or smell.

Have you been exposed to the coronavirus in the past 2 weeks?

Please select the option that most closely describes your level of exposure.

Exposed *

Yes
No

Yes, I have been in close proximity* to someone who has been diagnosed with or presumed to have COVID-19.

*Within 1.5m of the person for a prolonged period of time or being coughed on.

Sick Contact *

Yes
No

Yes, I have been in close proximity* to someone who is sick but has not been diagnosed with COVID-19.

*Within 1.5m of the person for a prolonged period of time or being coughed on.

Community *

Yes
No

Yes, I live, work, or have visited a place where COVID-19 is present.

Unexposed *

Yes
No

Are you Aboriginal or Torres Strait Islander? *

Yes
No

Are you? *

Aboriginal
Torres Strait Islander
Both

Name *

First

Last

Required-as it appears on your Medicare Card.

Date of birth *//

Gender *

Male
Female

As recorded with Medicare.

Do you have a mobile phone number *

Yes
No

Mobile Phone Number *

Mobile number starting with 04

Land Line Number *

Land Line number starting with 02

Confirm Mobile Number *

Confirm Land Line Number *

Do you have medicare? *

Yes
No

Medicare Number *

Please enter your 10 digit medicare numbers.

Medicare Reference Number *

Address *

Suburb *

Postal Code *

Do you want your results sent to your GP? *

Yes
No

Doctor Name: *

Doctors suburb: *

I consent to the clinic contacting me by Mobile Phone and SMS for the purpose of health information, test kit delivery and test results. *

Yes

Sorry, currently we are only offering testing for people who live in Sydney.

Based on the information you provided, we recommend that you not delay medical attention. Contact your healthcare provider as soon as possible to discuss your next steps in care.

If you feel like you are having a medical emergency, please call 000

Call ahead before visiting your healthcare provider. This will help the healthcare provider's office keep other people from getting infected or exposed.

If you have a medical appointment, let the healthcare provider know that you may have COVID-19

Put on a facemask before you enter the facility to limit exposure to others.

To contacta doctor Doctor anytime, anywhere visit Medinet

Or download the Medinet application below