• Covid-19 Patient Risk Assessment

      Are you following Government guidelines for Covid-19? check here > Check NHS website here.
      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? check here > Check NHS website here.
      YesNo

      Consenting to treatment

      I consent to treatment from Physio Therapy Centre 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.