• Covid-19 Consent & Self Assessment Form

    This form is require to be completed ahead of your appointment
  • Do you have a raised temperature, new cough or cold like symptoms?*
  • Do you have a change or loss of taste or smell?*
  • Have you been in contact with anyone with any of the above symptoms?*
  • Have you been in contact with anyone confirmed to have Covid-19 in the last 14 days?*
  • Have you or anyone you live with been asked to self isolate within the last 14 days?*

  • If you answered yes to any of the above, please contact us immediately and rearrange your appointment for a date 14+ days in future. 

    Failure to complete this form ahead of your appointment could lead to a refusal of service and you may still be charged for the appointment

    'No shows' who do not rearrange in line with our policies risk also being charged.

     

    Signing the below, you accept that your answers to abiove questions are true based on your understanding at the time of completion.

  • Should be Empty: