Howth Financial Services Ltd. – Pre-Appointment Covid-19 Questionnaire

Please complete the below form prior to your appointment. If the answer is ‘Yes’ to any of the below questions we would ask you to re-arrange your appointment. When on our premises, please ensure you follow our direction in respect of the use of hand sanitisers and use general respiratory etiquette with regard to coughing/sneezing.

Pre-Appointment Covid-19 Questionnaire
Full Name
Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness or flu like symptoms now or in the past 14 days? *
Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? *
Are you a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days? *
Have you been advised by a doctor to self-isolate at any time in the last 14 days? *
Have you returned to Ireland from any country not on the ‘Green List’ in the last 14 days? *
Do you object to your temperature being taken before entering the premises? *
Declarations *