Covid-19 Disclaimer
Following the Covid-19 pandemic, we've put extra measures in place for the safety of you and our staff members. We require all clients to complete this form so we can provide the best possible and safe experience to our clients and staff members.
Please carefully read and answer the below questions. This information will be stored confidentially and securely for 21 daysaccording to GDPR.
If you or a member of your household has developed a cough, fever, breathlessness, lack of taste/smell in the last 14 days, please inform a member of staff.
Email address *
1. Have you tested positive for Covid-19? If 'yes' please tell us the date *
Are you experiencing a persistent cough? *
Are you experiencing a shortness of breath? *
Have you had a fever (above 37.7C degrees) in the last 14 days? *
Have you noticed a loss or change in your sense of taste or smell? *
Have you had any contact with anyone that has suspected Covid-19 in the last 14 days? *
Personal details - Sign & date *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy