Covid-19 Consent Form

Following the COVID-19 pandemic, we’ve put extra measures in place for the safety of you and our staff members. We require all clients to fill in our COVID-19 form before arrival so that we can provide the best possible and safe experience to our clients and staff members.

 

Please carefully read and answer the below questions. This information will be stored confidentially and securely for 21 days.

 

If you or a member of your household has developed a cough, fever, breathlessness, sore throat or headaches in the last 14 days, please contact us before your appointment so we can obtain further information from you and advise.

 

Please get in touch if you have any questions - we’re looking forward to welcoming you back.  

1. Are you experiencing a cough?
2. Are you experiencing a shortness of breath?
3. Have you had a fever (above 37.7C degrees) in the last 14 days?
4. Have you noticed a loss or change in your sense of taste or smell?
5. Have you had any contact with anyone that has suspected COVID-19 in the last 14 days.
Agreement

Thanks for submitting!