Chimneys Guest House Covid-19 Questionnaire

1

Your booking reservation number* This field is required.Enter your unique booking reservation number provided by us or our partners

2

Full Name* This field is required.

First Name

Last Name

3

E-mail* This field is required.

Email Verified

The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification

••••

4

Mobile Number* This field is required.

Country Code

Phone Number

5

Arrival Date* This field is required.Our check-in timings are 14:00 - 21:00 PM

Date

Hour

Minutes

6

Departure Date* This field is required.Our check-out time is 10:00 AM on the day of your departure

Date

Hour

Minutes

7

Have you had any Covid-19 symptoms in the last 14 days?* This field is required.Symptoms include: A high temperature – this means you feel hot to touch on your chest or back; New continuous dry cough; A loss or change to your sense of smell or taste; Runny nose/sneezing (not hay fever related); Extreme tiredness; Sore/aching muscles and joints; Sickness or diarrhoea; Sore throat

Yes

No

8

Have you been diagnosed with Covid-19?* This field is required.

Yes

No

9

Have you been in close contact with or cared for someone diagnosed with or suspected of having Covid-19 within the last 14 days?* This field is required.

Yes

No

10

Have you been on a trip outside the UK in the last week 14 days?* This field is required.

Yes

No

11

Are you coming from abroad?* This field is required.

Yes

No

12

Please provide details if you are coming from abroad State the name of country and date of arrival to the UK. You must comply with UK Government guidelines and send us proof of compliance, which you may email to info@chimneys-guesthouse.com

13

Please verify that you are human* This field is required.