Corona Virus Risk Assessment

Covid-19 Risk Assessment

* Indicates required field

Name *

First

Last

Are you showing any signs of the Coronavirus? Including any of the follwing: high temperature, a new, continuous cough – you have started coughing persistently, loss or change to sense of smell or taste, new marks, rashes, spots, bumps, or other lesions on your skin or toes. Check https://www.gov.uk/coronavirus for current list of symptoms *

Yes No

Are you defined by the Government as being extremely vulnerable and shielding? (those with an NHS letter or contacted by their GP) These include those with the following conditions: weakened or compromised immune systems, transplants, severe lung conditions, severe asthma, severe COPD, born with serious heart condition or are pregnant, etc. See: https://www.nhs.uk/conditions/coronavirus-covid-19/people-at-higher-risk/ *

Yes No

Have you been in contact, in the last 14 days, with someone who has been diagnosed with or suspected of having the Coronavirus or been contacted by NHS Track &Trace team and advised to self isolate? (IF ANSWER IS YES PLEASE EXPLAIN BELOW) *

Yes No

Please specify any details below if necessary. *

Please confirm that to the best of your knowledge you do not have coronavirus and you are happy to go ahead with the treatment *

I confirm

Please confirm that you are happy to wear a face mask during your treatment, unless you have a medical condition that allows you not to. *

I confirm NA

Submit

Covid-19 Risk Assessment

I look forward to treating you soon!

Opening Hours

Telephone

Email

Covid-19 Risk Assessment

​I look forward to treating you soon!

Opening Hours

Telephone

Email

I look forward to treating you soon!