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Health Declaration form

It is important that any person who enters the clinic or has a home or work appointment  is medically and physically fit and is not a danger to themselves or the health and safety of others.

Please fill out the following health declaration form between 48h and 24h before your appointment with us

If you are not sure, you should seek medical guidance from NHS 111


If you are tested for COVID-19 and it is confirmed, you must immediately advise us

Are you experiencing any of the following symptoms? please tick the box if relevant
Have you been exposed to a confirmed case of Coronavirus, or had contact with person(s) with flu-like symptoms?
Have you travelled abroad in the past 14days ?

Thanks for submitting!

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