COVID-19 Liability Waiver

Self-Declaration by Client

1. I HAVE NOT travelled abroad in the last 14 days.

2. I HAVE NOT had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days.

3. I HAVE NOT been in close contact with anyone who has travelled abroad within the last 14 days.

4. I HAVE NOT experienced any cold, cough or Flu like symptoms in the last 14 days. (This includes sore throat, respiratory illness, difficulty breathing)

If the answer is "yes" to any of the above questions, access for treatment will be unfortunately be denied. 

Thanks for submitting!