COVID-19 Screening Go backYour message has been sent Thank you for providing this information. With best wishes, Nina Please complete within the 24 hours before your appointment: Name(required) Warning Phone(required) Warning Date (YYYY-MM-DD)(required) Warning Do you have any of the following symptoms? New persistent cough(required) Yes No Warning Raised temperature (over 37.6°C)(required) Yes No Warning Change or loss of taste or smell(required) Yes No Warning Have you experienced any of these symptoms in the past 10 days?(required) Yes No Warning Are you currently self-isolating?(required) Yes No Warning Have you knowingly been in contact with a positive Covid case within the previous 72 hours (3 days and 3 nights)?(required) Yes No Warning Have you travelled overseas in the last 7 days?(required) Yes No Warning Additional information Warning 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) Warning Warning! submit formSubmitting form Δ Share this: Click to share on X (Opens in new window) X Click to share on Facebook (Opens in new window) Facebook Like Loading...
Reiki For Life Now 