Covid-19 Health Declaration & Treatment Consultation
Face masks must be worn at all times throughout your treatment.
Myself or anyone in my household have not been advised to shield by the government
I am not experiencing any of these symptoms: fever, cough, sore throat, loss of taste or sense of smell (or any other flu like symptom)
I have not been in close contact with anyone who has tested positive for Covid-19 within the last 14 days
Please select any that may apply:
Any skin rash or condition
Surgeries (within past 12 months)
High blood pressure
Fibromyalgia/ Chronic fatigue
Any contagious disease/ Illness
Allergies to Acrylics, Plastics, Other
Injuries (within past 12 months)
Other medical condition
I declare that the info I’ve provided is accurate & complete
Thanks for submitting!