Covid-19 Symptoms Checker Form

Due to the ongoing and rapidly changing situation with COVID-19, we are requiring all visitors to Clinic4sport clinics to make a health declaration. Clinic4sport will rely on this declaration to protect your health and the health of practitioners and patients.

Patients must complete and submit this below form prior to their appointment.

If during your visit you experience any of the symptoms below, you must immediately notify your practitioners.

I confirm that I will not attend Clinic4Sport clinics if any of the below apply.

1. I am experiencing any of the following symptoms:
– a high temperature/flu-like symptoms
– a new, continuous cough
– a loss or change to my sense of smell or taste

2. I have entered the UK from another country within the last 14 days

3. I am aware that either myself or a member of my household have come into contact with a person with a confirmed case of Covid-19 in the last 14 days

I agree to comply with all applicable government guidance on social distancing and self-isolation during my visit and any site rules by Clinic4Sport including wearing a face mask at all times during my visit.