COVID Form

YOUR HEALTH.....Have you experienced any of the following?

Cough Shortness of breath Fever of 37.5 or higher Aches, pains, sore throat, headache, or loss of taste or smell None of the above

TRAVEL

Have you travelled internationally within the past 14 days? Have you come into contact with any suspected, probable or confirmed COVID-9 cases within the last 14 days? None of the above

YOUR APPOINTMENT.....Please read each of the following carefully and tick to indicate that you understand agree.

~I agree to follow strict hygiene practices while at my appointment including washing and sanitising my hands on arrival, and comply to instructions during the service. ~I will not bring anyone unrelated to my appointment. ~I agree to maintain physical distance where possible.I understand that the current climate has changed temporarilly and the usual procediures will be different. ~I understand that my appointment may need to be rescheduled with very short notice. if this occurs a new time will be found in line with government guidelines. ~I agree to let you know if any details change, particularly if i develop symptoms or are exposed to COVID-19.