• Updated 27th September 2021 - Coronavirus (COVID-19)

     

    • Covid-19 Patient Risk Assessment

      Are you following Government guidelines for Covid-19? https://www.gov.uk/coronavirus
      YesNo

      Have you been in contact with anyone with Covid-19 symptoms in the last 14 days?
      YesNo

      Have you had any Covid-19 symptoms in the last 7 days?
      YesNo

      Have you been double vaccinated over 14 days ago?
      YesNo

      Are you in a high risk group for Covid 19? https://www.nhs.uk/coronavirus/people-at-higher-risk
      YesNo

      Consenting to treatment

      I consent to treatment from Chichester Physio Ltd and understand the risks of Coronavirus and appreciate that all precautions are in place to minimise this risk. I agree to inform the clinic if my circumstances change in relation to the questions above.
      YesNo

      Digital Signature

      Please use the mouse if on a computer to add your signature or your finger if using a tablet or mobile.