Please complete and submit this form no later than 24 hours before your appointment. Please don’t hesitate to contact me if you have any questions or problems on 07985 265905 or email me at gail(Replace this parenthesis with the @ sign)

If you are not able to take you temperature you can check if you feel hot to touch on your chest or back (this can indicate you have a 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.
Although you are no longer required to self isolate we will need to re-arrange your massage appointment if you are still showing a positive lateral flow or PCR test result.
People react differently to the COVID vaccine. For this reason, no treatment can be undertaken within 48 hours of receiving the vaccine
If you have been diagnosed with long Covid, we will discuss how to adapt your massage to assist you in your recovery.
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.