• PlayFULL Potential COVID-19 Self Screening Questionnaire

  • You must answer “NO” to all the questions in this questionnaire in order for your scheduled therapy session to take place. If you answer “YES” to any of the questions, in-person therapy will not occur, your therapist will be in touch to arrange an alternative method of service delivery.

     

    When answering the questions below, please be sure your responses include the health status of ALL members of your household.

     

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    Pick a Date
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  • *Face-to-face contact within 2 metres

    ** Ill/symptomatic means someone with COVID-19 symptoms on the list above

     

    Given that we work with many individuals with compromised immune systems, we appreciate your honesty and effort in completing this form. 

    I certify to the best of my knowledge; this information is accurate.

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