This form is for patients of the Palms GP Surgery with symptoms only. If you are seeking testing because you are a close contact of someone with confirmed COVID 19 but have no symptoms please click here

On weekends and bank holidays do not submit this form. Please contact Caredoc on 0818 300 365

If you feel you require urgent clinical assessment do not use this form. Please contact the surgery on 053 9421336 or Caredoc out of hours on 0818 300 365

Due to the increased volume of phone-calls about Covid 19 testing in light of broadening of testing criteria announced by the HSE, we now asking symptomatic patients to fill out the following questionnaire to help us assess you more efficiently.

We understand our patients are concerned for themselves and their loved ones and we can assure you are doing everything we can to operate as normally as possible in these extraordinary times, while at the same time minimising the risk of exposure to our patients, and indeed our Practice.

Please Fill Out the Form Below to Help Us to Triage Your Symptoms to See if You Need to be Tested for COVID 19.

You will be contacted by phone by one of our doctors.

PLEASE NOTE: ANY FORMS SUBMITTED AFTER 2PM WLL NOT BE CONTACTED UNTIL THE FOLLOWING DAY

THIS IS NOT FOR URGENT CLINICAL QUERIES. IF YOU ARE CONCERNED ABOUT YOUR SYMPTOMS PLEASE CONTACT THE SURGERY BY PHONE ON 053 9421336 OR CAREDOC OUT OF HOURS 0818 300 365

Please tick all symptoms that apply