Covid Questionnaire

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Success! Message received.

Address: 64 Upper St James Street

Brighton

BN2 1PJ

Tel: 07855 850 733

Session availabilty

Monday 6.00am to 9.00pm

Tuesday 6.00am to 9.00pm

Wednesday 6.00am to 9.00pm

Thursday 6.00am to 9.00pm

Friday 6.00am to 9.00pm

Saturday 7.00am to 5.00pm

Sunday Closed

All sessions are by appointment only.