Genki Clinic - CoronaVirus Consent
Thanks in advance for your help: We can only treat you if you have completed this form before each treatment.
Elective Treatment *
Required
COVID-19 Risk *
Required
COVID-19 - Prevention Measures *
Required
Treatment Permission *
Required
Wellness Declaration *
Required
Travel Declaration *
Required
Contact Tracing *
Required
First Name *
Surname *
Email *
(for clinic communication only)
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