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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.

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

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If you are not sure, you should seek medical guidance from NHS 111 https://111.nhs.uk/covid-19

 

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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