Covid Screening Form

Please fill in your details and then indicate whether you or any of your household members have any of the symptoms below. This is an enhanced list, so there may be a few questions in addition to those you have seen before. Once you’ve finished the first section click submit and move on to the next section. Please note, this should be completed on the day or day before your appointment. If anything changes, you MUST contact Reach. If you need to reschedule for a reason related to this list you will not be charged – your health and safety is our priority. As always, contact us if you have any questions or concerns.

 

If the answer is yes to any of the above, then treatment cannot commence until an isolation period in line with Government Guidance has been completed and you can confirm you are symptom free.

 

Consent Declaration for Face to Face Appointments during Covid-19

The information I have given in this form is honest, accurate and correct to the best of my knowledge.I have had the opportunity to ask all the questions about its content, and all of my questions have been answered to my satisfaction.I appreciate that although all reasonable steps to reduce risk of infections have been taken, including screening potential Covid-19 cases and undertaking increased hygiene and distancing protocols there may still be a risk of infection from face to face treatment. I knowingly and willing consent for face to face appointments to take place.