Covid 19 Pre Treatment Questions & Guidelines

Covid 19 Pre Treatment Form & Guidelines

Covid Pre Treatment Form

Please complete and submit this form no more than 24 hours prior to treatment and contact us if you have any questions.

Please check your temperature on the morning of your treatment.
If it is higher than 37.8 degrees or if you have any other symptoms please contact us to defer your treatment.
Please ensure that you follow all new procedures explained to you by us prior to treatment.

Please defer your treatment if:

You are waiting for a COVID 19 test result
You have recently tested positive for COVID 19
You have a high temperature above 37.8 degrees
You have a continuous cough
You have changes to your sense of smell or taste

If you currently had symptoms of COVID 19 but have not yet used the NHS 111 online coronavirus service please do so.

If you have any other new or unusual symptoms please discuss these with your therapist before your appointment by calling 01303487220 or emailing [email protected]

We have carried out a full risk assessment and adhere to COVID 19 guidelines produced by the government & our professional association The Federation of Holistic Therapists (FHT), for more information visit fht.org.uk/coronavirus

Name*

Email Address*

Address*

Date of Treatment

Type Of Treatment*

Do you currently have COVID 19 or symptoms of COVID 19? If yes please defer your treatment and gain consent from your GP or Consultant prior to rebooking.*

YesNo

Have you had COVID 19? If yes please seek consent from your GP or Consultant before treatment*

YesNo

Does anyone in your household or support bubble have COVID 19 or symptoms of COVID 19? If yes please defer your treatment for at least 21 days & ensure that the member of your household or support bubble have been free of symptoms for at least 7 days.*

YesNo

Have you been in close contact with anyone else in the past 14 days who has symptoms of COVID 19 or been contacted by the NHS test & trace service & been told to self isolate? If yes please defer your treatment for at least 14 days or however long the test & trace service have advised you to self isolate.*

YesNo

By ticking this box I am signing to say that I have answered these questions honestly and to the best of my knowledge*

Select this box to provide your Electronic signature

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