Sore Throat screening questions Sore Throat Screening Form Sore Throat screening questions (#16) Is under the age of 5 years? Yes NoIs immunosuppressed Yes NoHas had a change in their voice eg. hoarse, raspy or strained Yes NoIs under the age of 16 years and is pregnant, or there is a chance they might be pregnant Yes NoIs having difficulty swallowing Yes NoIs drooling Yes NoHas visible swelling or experiencing pain in the neck Yes NoHas recently developed a rash Yes NoHas a white coating on the tongue OR tongue has a red, strawberry appearance Yes NoHas a flushed face Yes NoIs feeling generally unwell Yes No UNFORTUNATELY YOU DO NOT QUALIFY FOR THIS SERVICE, PLEASE CONTACT YOUR GP AS SOON AS POSSIBLE.Select all that apply Symptoms appeared less than 72 hours ago I do not have a high temperature (38 C or higher) I do not have visible pus on your tonsils (white patches) I do not have severely inflamed tonsils I do not have a cough or cold symptomsAntibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.Antibiotics make little difference to how long symptoms last and not taking them is unlikely to lead to complications. Manage your symptoms with appropriate pain relief and / or suitable medicated lozenges or throat spray). Drink plenty of fluids. Contact us again for re-assessment if your condition deteriorates or doesn’t improve within 3 days.PreviousNextFull NameEmailPhone/MobileDate Of Birth Previous Submit Form