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COVID-19 Declaration Form

Please complete this form when you book an appointment with Chris.

COVID-19 Declaration

Please complete this form for every appointment with Chris
  • Date Format: MM slash DD slash YYYY
    If the answer to this question is yes, then the treatment can not continue until after 2 weeks of isolation with no symptoms in the household.
    Chris will contact you the day before to see if anything has changed, and you will also be asked these questions when you arrive at the Centre.
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