Date of filling: 26.10.2021 18:43:58 (appears automatically)
Clinic of planned treatment
Kokshetau, Auelbekova Street 129/20
Uralsk, Ikhanova Street 52
Atyrau, Kulmanova Street 1 (Grand Atyrau Residential District)
Ust-Kamenogorsk, Nursultan Nazarbayeva Ave. 29/23
Almaty, Kabanbai Batyra Street 122A
Almaty, Rozybakiyeva Street, 105 B
Almaty, Sholokhova Street 15
Nur-Sultan, Saraishyk Street 5, VP11
Nur-Sultan, Abay Ave. 28
Nur-Sultan, Kazhymukana Street 12
1. Have you and your child been in isolation or self-isolation for the last 14 days before visiting the clinic?
2. Were there any close contacts over the past 14 days with a person under the supervision due to COVID-19, who subsequently become ill?
3. Were there any close contacts over the past 14 days with a person who was diagnosed with a laboratory confirmed COVID-19?
4. Have you and your child visited a clinic or medical centre where patients are tested for COVID-19?
5. Have you and your child experienced one or more symptoms in the last 14 days?
increased body temperature over 37.5C
cough (dry or with a small amount of sputum)
shortness of breath
feeling of stuffiness in the chest
myalgia - muscle pain
I and my child experienced none of the symptoms listed above
6. Have you tested for COVID-19?
I understand that the provision of false information is a violation of the law in sanitary and epidemiological welfare of the population and it entails corresponding responsibility.