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This Questionnaire is an essential step in ensuring we can protect you and others from the risks of Covid-19 during this pandemic.

Please complete before your session, failure to do so may require us to move or cancel your appointment.

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This questionnaire has to be completed for anyone who is attending viewing.

Maximum 2 adults are allowed to view. Children below 15 years of age are not allowed to view.

Please note we may do a temperature check before the appointment.

Those who refuse to wear mask (unless they present exemption card) will be refused an appointment.

Please read the following information relating to COVID-19 as it is important that this is acknowledged prior to your appointment. If you answer YES to any of the following questions then your agent will need to have a discussion with you prior to your appointment.

I have read the above statement and agree I do not understand this and require a confirmation phone call

COVID-19 Declaration

Please read the symptoms listed below:

A new, continuous cough
A high temperature
Unusual shortness of breath or difficulty breathing
A loss or change of taste or smell

Chills
Muscle pain* without explanation
Headache* without explanation
Sore throat
Diarrhoea
Vomiting
Pain or pressure in the chest
Episodes of confusion

More information on https://www.nhs.uk/conditions/coronavirus-covid-19/symptoms/

Have you, or anyone in your household experienced any of the above symptoms in the past 14 days? *

No Yes In the past 14 days, have you been in contact with anyone who has suspected, or tested positive for Covid-19? *

No Yes I confirm the information provided is accurate to the best of my knowledge. *

I confirm

COVID-19 Pre-Appointment Questionnaire Declaration

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COVID-19 Declaration