Health declaration form

    PATSIENT
    Name and surname*
    Personal ID code*
    PARENT
    Name and surname*
    Personal ID code*

    1. Have you or someone from your family been in contact with somebody who has been diagnosed of having Covid-19 infection in past 10 days? *

    when (date/month)

    2. Do you have any of the following symptoms?*

    3. Have you had a COVID-19 TEST with a POSITIVE result?*

    when (date/month)

    4. Have you completed a full vaccination course according to the vaccine regimen*:
    Pfizer/BioNTech COMIRNATY – 7 days after the second dose of vaccine;
    Moderna – 14 days after the second dose of vaccine;
    AstraZeneca VAXZEVRIA – 15 days after the second dose of vaccine;
    COVID19 Vaccine Janssen – 14 days after the dose of vaccine.

    NB! According to the Estonian law „Communicable Diseases Prevention and Control Act(&47)“ violation of requirements for control of communicable diseases is punishable.

    Attention:

    • Please wear the face mask in clinic premises.

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