Call: 079632 19368   |   Email: andrea@clinic-10.com
  079632 19368   |   andrea@clinic-10.com

Covid-19 Screening Form

Covid-19 Screening Form
in accordance with our guidelines, it is necessary to ascertain the risk posed. Please fill and return this online form promptly so that the booking process can be completed.

YOUR DETAILS

SECTION 1: COVID-19 SPECIFIC

SECTION 2: GENERAL

DECLARATION

If you have any problems or are unsure on how to answer this questionnaire, please contact us promptly on 07963 219368.
If you are unable to sign the signature box below, please just tick this box in lieu.

What our lovely clients say

Don’t believe that we can transform you? See below for a few of our testimonials!