Health Declaration

Please fill out the following health declaration form ahead of your upcoming treatment session with Diagnostic Therapy. This form will gauge your suitability to receive treatment and also acts as a consent form, acknowledging the risks involved with face to face treatment under the current COVID-19 pandemic. Submissions are valid up to 24 hours prior to the activity. 
*Required
COVID SCREEN: Do you or your household members have any of the COVID-19 symptoms, namely; a fever, new persistent cough, sore throat, shortness of breath, or a loss of taste or smell? (If the answer is yes, your appointment will need to be postponed and you will be required to self isolate)
Do you to your knowledge have any bloodborne pathogens present in your blood, namely Hepatitis B or C, or HIV?