Rebecca Webb Physiotherapy Coronavirus COVID-19 Screening questionnaire
Welcome to Rebecca Webb Physiotherapy Coronavirus COVID -19 screening

Thank you for participating in our screening questionnaire. Your completion of this questionnaire is an important Coronavirus COVID -19 safety procedure of our clinic. We can not provide a face to face appointment if Coronavirus COVID -19 screening is not complete.

Please do not attend clinic if you have;
a high temperature
a new, continuous cough
a loss of, or change to, your sense of smell or taste

Please see the Government website for more information https://www.gov.uk/coronavirus
Name *
Address *
Email *
Phone *
Do you have a high temperature or fever? *
Do you have a new continuous cough? *
Do you have a loss of, or change to, your sense of smell or taste *
Have you been diagnosed with or suspected to have COVID - 19? *
Does a member of you household currently have COVID - 19? *
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