COVID-19 Declaration Please read the following carefully and confirm that you are happy to proceed with treatment: Due to the Coronavirus pandemic, we are required to take to take extra precautions when seeing patients face-to-face. It is important to understand that there is a risk of infection, when attending Physiotherapy treatment.Do not attend if you or your family presented with COVID-19 symptoms in the last 7 days:Chronic dry cough,Increased temperature or feverLoss of smell/tasteHeadaches. I confirm that neither I nor anyone in my household have presented with any of the COVID-19 symptoms within the past 7 days. PROTOCOL WHEN ATTENDING APPOINTMENTS: Use the allocated undercover Regus parking (particularly if it is raining). There are currently no parking restrictions/ permits required at Regus. Wait in your car or outside the main Regus door until your appointment is due. Inform you physiotherapist by WhatsApp or Text Message on 07736731022 that you have arrived. Do not enter the Regus waiting room, bathrooms etc. and do not touch any Regus door handles. Your physiotherapist will meet you and supply you with hand sanitiser and PPE. Do not wear any gloves - you will be asked to remove this on first contact with us. Inform your physiotherapist if you have any allergies to latex or powder, prior to the appointment. Only the patient that is receiving treatment on the day, will be allowed into the clinic. If the patient requires a chaperone, let us know, prior to the appointment. Do not bring any unnecessary belongings including handbags/sunglasses etc. The treatment duration is 30-45min. Just before leaving the clinic you will be required to dispose of your gloves and use hand sanitiser again. Keep your mask on UNTIL you washed your hands with soap. Methods of payment: ONLY Cards are currently accepted. Consider remote consultations if you think that the problem can be resolved in that manner. I confirm that I have read and understand this information. Patient First Name Patient Last Name Patient Date of Birth Telephone Number (Parent number if patient is under 18) Email Address (Parent address if patient is under 18) Time is Up!