Daily COVID-19 Consent and Screening

By signing this form you understand that despite all our best efforts to avoid infection, therapy does carry the risk of COVID-19 exposure and potential infection. At the time of your treatment your therapist is not currently exhibiting any flu like symptoms and to her knowledge has not been in contact with anyone who is ill or COVID 19 positive

COVID Daily Screening

Please complete this screening before every visit to the practice
Name of Parent(Required)
Name of Child(Required)
MM slash DD slash YYYY
Time(Required)
:
I confirm that(Required)
For those parents staying in the session

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For more information about COVID-19 please visit: COVID-19 Corona Virus South African Resource Portal

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