Online assessment | holisticgrove

Please note: if you are defined by the Government as being at extremely vulnerable and shielding (those with an NHS letter or contacted by their GP), unfortunately I wont be able to treat you unless you have a medical agreement to allow me to treat you.

If you have been defined by the Government as being *vulnerable, please contact Justine directly so that she can check current Government guidelines whether to treat or not.

*These include those with the following conditions:
Pregnancy, being elderly (over 70), long term conditions such as diabetes, non-severe lung conditions, heart conditions, etc. This list may change, see: https://www.nhs.uk/conditions/coronavirus-covid- 19/people-at-higher-risk-from-coronavirus/whos-at-higher-risk-from-coronavirus/

Covid-19 Risk Assessment

Please see Massage or Reflexology page above for details on what measures have been put in place to ensure your safety in the treatment room.

Please complete the following health risk assessment in order to determine if its safe to go ahead with your treatment with Holistic Grove Therapies. Your treatment will not go ahead unless this has been completed.

You will be asked to complete this form at least 24 hours prior to your scheduled appointment.

If you notice any symptoms after completing this form, please contact Justine immediately.

All fields are mandatory thank you.

Justine has received her first dose of Covid-19 vaccination and will receive the 2nd dose mid May. She will also take a lateral flow test twice a week.

First Name

Last Name

I am NOT experiencing a high temperature nor have I noticed my back or chest is hot to the touch.

Are you experiencing any of the following: A new, continuous cough, loss or change to sense of smell or taste or new marks, rashes, spots, bumps, or other lesions on their skin or toes

Yes

Have you been in contact, in the last 14 days, with someone who has been diagnosed with or suspected of having the Coronavirus or been contacted by NHS Track &Trace team and advised to self isolate?

Covid 19 Vaccination Status

Date

Initials

Thanks for submitting!