COVID-19 Screening ← BackThank you for your response. ✨ Thank you for providing this information. With best wishes, Nina Please complete within the 24 hours before your appointment: Name(required) Phone(required) Date (YYYY-MM-DD)(required) Do you have any of the following symptoms? New persistent cough(required) Yes No Raised temperature (over 37.6°C)(required) Yes No Change or loss of taste or smell(required) Yes No Have you experienced any of these symptoms in the past 10 days?(required) Yes No Are you currently self-isolating?(required) Yes No Have you knowingly been in contact with a positive Covid case within the previous 72 hours (3 days and 3 nights)?(required) Yes No Have you travelled overseas in the last 7 days?(required) Yes No Additional information By submitting this information, I declare that the information I have provided is true and correct and I have disclosed all relevant facts relating to this matter that I am aware of. I understand that it is my responsibility to bring such matters to the attention of the Reiki Practitioner prior to any treatments being provided. I confirm that I have read and agree to the above statements(required) submit formSubmitting form Δ Share this: Share on X (Opens in new window) X Share on Facebook (Opens in new window) Facebook Like Loading...
Reiki For Life Now 