You must fill in and submit this form prior to your appointment if you have not been to the clinic before July 2020. This is a legal requirement
(Form filling time: 5 minutes)
To keep you safe during the Covid-19 pandemic management, we need to make sure that any face to face clinic appointments are both appropriate and safe.
Face to face appointments should be currently limited to:
- those whose treatment cannot be performed effectively with a video appointment
- those who have pain or dysfunction which is limiting work, exercise, activities of daily living or affecting them emotionally or psychologically.
I understand that because my treatment may involve close physical proximity and touch over a prolonged period of time, there may be an elevated risk of disease transmission, including Covid-19.
I have read the clinic protocol and I am happy with the measures that have been taken mitigate these risks
I understand that my details may be used to contact me if required as part of the 'Track and Trace' system.