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 *

Are you defined by the Government as being vulnerable? These include those with the following conditions: Pregnancy, being elderly (over 70), long term conditions such as diabetes, non-severe lung conditions, heart conditions, etc. This list may change, see: https://www.nhs.uk/conditions/coronavirus-covid19/people-at-higher-risk-from-coronavirus/whos-at-higher-risk-from-coronavirus/ *

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-fromcoronavirus/whos-at-higher-risk-from-coronavirus/ *

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) *

Any comments *

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!