COVID 19 Screening Questionnaire
To comply with current DHHS regulations, we need to ensure all sessions conducted are of an essential nature.

This Questionnaire is compulsory for all patients prior to each face to face appointment, to minimise risk of infection to both patients and practitioners.
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Please read the following questions carefully and answer truthfully. Please be aware that this declaration is a legal document that can be audited by DHHS.

Upon submission, these answers will be reviewed by your practitioner, if there are any concerns they will be in contact.

ReachHealth is committed to ensuring the health and safety of our entire community. Thank you for your understanding in these challenging times.
Full name:
Best number to reach you:
What has lead to you seeking an Osteopathy or Acupuncture appointment today?
Have you visited any of these sites during the dates/times listed, or within 1 hour of the listed time?
Clear selection
Are you awaiting COVID-19 test result?
Clear selection
Have you had close contact with someone confirmed to have COVID-19?
Clear selection
Do you currently have a fever?
Clear selection
Do you currently have a cough? (ANY cough, whether it be dry, productive, related to allergies or known pre-existing conditions)
Clear selection
Do you have a sore throat, loss of taste or smell, nausea, or any other signs of infection?
Clear selection
How much exposure have you had to large numbers of people in the last 14 days?
Clear selection
Are you happy to see your Osteopath / Acupuncturist, knowing that despite our best efforts at hygiene we cannot in a face-to-face consultation mitigate all risk? (Current hygiene policy here -
Clear selection
If you do get diagnosed with COVID-19 in the next 14 days, will you contact your treating practitioner as soon as feasibly possible?
Clear selection
This declaration is a legal document and may be audited by DHHS.
By completing and submitting this form you agree that this declaration is a legal document and may be audited by DHHS.
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