At Maga Therapy we value health. As a result of COVID-19, there are some legally required changes.
This post discusses one of the forms which you will be required to bring on the day of your treatment – Covid-19 screening information. You will be sent this when you book your massage or other permissible treatment.
Before you enter the building I will scan (and record) your temperature. Please know that for your assurance, I will also scan and record my temperature. If the reading is above 37.8 you will not be allowed to enter the building.
There are other requirements in align with the new regulations. Please
|Have you had a Covid-19 test||YES||NO|
|Did you self-isolate||YES||NO|
|What was the date you tested negative|
|Do you still have symptoms||YES||NO|
|Are you registered on the NHS Track & Trace app||YES||NO|
|SYMPTOMS – Are you experiencing any of the following?|
|Severe breathing difficulties or chest pain||YES||NO|
|Difficulty in waking or confusion||YES||NO|
|If yes to any of the above call 999|
|Previous symptoms getting worse: cough||YES||NO|
|Sore throat or runny nose||YES||NO|
|If any of the above, the advice is to self-isolate for 7 days|
|Chills or headache||YES||NO|
|Muscle & joint ache||YES||NO|
|Fatigue or exhaustion||YES||NO|
|Loss of taste or smell||YES||NO|
|If any of the above, the advice is to self-isolate for 7 days. Then taking a test will be necessary. Call 119.|
|Shortness of breath or difficulty lying down due to chest issues||YES||NO|
|If any of the above, contact your GP or call 111|
|Have you been in contact with anyone with Covid-19 symptoms?||YES||NO|
|Have you had or are you now experiencing Covid-19 symptoms?||YES||NO|
|Are you taking your temperature regularly? If so, what is the latest?||YES||NO|
|Have you recently been hospitalised?||YES||NO|
|If so, why – please describe:|
|Do you have any of the following health issues|
|High blood pressure or other heart condition||YES||NO|
|Diabetes Type 1 or 2 – if so, which?||YES||NO|
|Any other conditions – please list:|
|An NHS front line worker||YES||NO|
|A carer – home or care home||YES||NO|
|Shielding a vulnerable adult||YES||NO|
|Pregnant – how many weeks?||YES||NO|
|Over 70 – will you have a companion with you?||YES||NO|
|Allergic to latex gloves||YES||NO|
|Allergic to cleaning products – if yes please specify||YES||NO|
I solemnly and sincerely declare that the information I have provided is true and correct and I make this solemn declaration conscientiously believing the same to be true. If any person should suffer as a result of the information being found to be untrue and false, then I am aware I can be prosecuted for making a false declaration.
If either I or someone I have been in contact with tests positive for Covid-19 or have been contacted by NHS Track & Trace I will inform you.
I consent for you to inform NHS Track & Trace if so required.
Full name: ………………………………………………
THERAPIST DECLARATION & CONSENT FORM – COPY FOR CLIENT
|I do not have Covid-19 to my knowledge
|I have/ have not been tested for Covid-19
|The test was negative
|I take my temperature every day
|I have not been in contact with anyone with Covid-19, to my knowledge
|I am connected to the NHS Track & Trace app
|If either I, or a client, tests positive for Covid-19 I will inform you immediately
I solemnly and sincerely declare that the information I have provided is true and correct and I make this solemn declaration conscientiously believing the same to be true.
If any person should suffer as a result of the information being found to be untrue and false, then I am aware I can be prosecuted for making a false declaration.
Full name: ………………………………………….