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About Me
Code of Conduct
RolfingĀ®
Blog
FAQ's
Contact
Book Online
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YOUR CART
Covid-19 Pre-consultation Screening Questionnaire
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Name
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First
Last
Have you received two doses (or more) of a Covid-19 vaccine or have a medical exemption?
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Yes
No
If no, I ask that you wear a KN95, N95 or P2 mask in the session. If you have any concerns please let me know.
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Are you or anyone in your household currently experiencing any symptoms of Covid-19 (sore throat, cough, blocked or runny nose, loss of smell and taste, fever, diarrhoea, headache or difficulty breathing?
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Yes
No
If yes, please provide further details.
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Have you or anyone in your household been diagnosed with Covid-19 within the last 14 days?
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Yes
No
If yes, please provider further details.
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Are you or anyone in your household waiting on results of a Covid-19 test?
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Yes
No
Are you or anyone in your household currently a Close Contact?
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Yes
No
Do you have any reason to believe that you may have been exposed to Covid-19?
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Yes
No
If you need to provide any further info before your session please do so here or feel free to contact me directly.
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