To ensure safety for all, please complete this short COVID-19 questionnaire.

All fields marked * are mandatory.

Personal Details

We may occasionally contact you with offers of products and services can we contact you?

Yes I agreeNo I do not agree

 

Your Health

Have you tested positive for COVID-19, or been in contact with someone who has in the past 14 days?

Have you been tested for COVID-19 and are currently awaiting the test results?

Do you have any of the following Flu like symptoms:fever, dry cough, body aches, headaches, sore throat, runny nose, shortness of breath? (note: this refers to new or unusual symptoms not aligned with medical history. You may exclude known personal medical conditions that have the same symptoms eg. allergies, history of migraines.)

Are you or your immediate contacts in a high risk category?

Have you travelled abroad in the last 14 days?

Please note if you answered yes to any of the above questions, unfortunately we are unable to give you an in person treatment.