COVID-19 Pre-Screening Questionnaire

Please complete and submit this form no later than 24 hours before your appointment. If you are in the High Risk {Extremely Vulnerable) Group please allow extra time so I may contact you to ensure you can provide informed consent.  Please don’t hsitate to contact me if you have any questions or problems on 07985 265905 or email me at gail(Replace this parenthesis with the @ sign)poiseremedialmassage.com

This means you feel hot to touch on your chest or back ( you do not need to measure your temperature)
This means coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours. (If you usually have a cough, it may be worse than usual)
This means you've noticed you cannot smell or taste anything, or things smell or taste different to usual.
If you answered yes, then treatment cannot commence until an isolation period in line with Government Guidance has been completed and you can confirm you are symptom-free
If you answered yes, then treatment cannot commence until an isolation period in line with Government Guidance has been completed and you can confirm you are symptom-free
If you are in the 'At Risk' Group, you will need to give informed consent to show that you have been explained, understood and been given the opportunity to ask questions about Poise's Risk Assessment and Protocols to reduce the risk of infection, including face-to-face treatment and its increased risk of COVID infection and its consequences. I will contact you separately if you answered YES to this question.
People react differently to the COVID vaccine. For this reason, no treatment can be undertaken within 48 hours of receiving the vaccine
The information I have given in this form is honest, accurate and correct to the best of my knowledge. I have had the opportunity to ask all the questions about its consent and all of my questions have been answered to my satisfaction. I appreciate that although all reasonable steps to reduce risk of infections have been taken, including screening potential COVID-19 cases and undertaking increased hygiene and distancing protocols there may still be a risk of infection from face-to-face treatment. I knowingly and willingly consent for face-to-face appointments to take place.