Important COVID-19 Announcement
COVID-19 Screening Book Now

Physiotherapy & Rehabilitation

COVID-19 Screening Questionnaire

For the health and safety of our therapists, staff and all others within the clinic, please answer all questions below honestly.
  • Name and Date

  • Date Format: MM slash DD slash YYYY
  • 1. In the last 14 days, have you...

  • ** If you have answered "yes" to any of the following questions please DO NOT ENTER**
  • 2. Do you have any of the following “A symptoms?”

  • 3. Do you have 2 or more of the following “B Symptoms?”

  • If you answered yes to ANY of the above, please explain: