Skip to Main Content
Moving Beyond Stress Workshops
Covid-19 Health Declaration
How are you feeling today?
Child's Name (if applicable)
Have you experienced any of the following symptoms within the last 14 days? Please tick if applica le.
Flu like symptoms
Other symptoms including aches and pains, sore throat, headache or loss of taste or smell
None of the above
Have you travelled internationally within the last 14 days?
Have you come into contact with any suspected, probable or confirmed COVID-19 cases within the last 14 days?
Please read each of the following statements carefully and tick to indicate that you agree.
I agree to follow strict hygiene practices while at my appointment including washing or sanitising my hands on arrival, and will comply with staff instructions during my service.
I will not bring anyone unrelated to my service with me to help limit the number of people on the premises.
I agree to maintain a physical distance as much as possible and understand some elements of my visit may be slightly different to accommodate social distancing guidelines.
I understand that in the current, fast moving climate, my appointment may need to be rescheduled with short notice. If this happens, a new time will be found in line with any government guidance.
I agree to let you know if any of the details I have given change, particularly with regards to developing any symptoms of, or exposure to COVID-19.
I declare that the info I’ve provided is accurate & complete
Thanks for submitting!