Covid Screening

Welcome to your Covid Screening

Client name:

Appointment date:

Have you had a high temperature? (this can mean feeling hot to touch on your chest and back - you do not need to measure your temperature)

Have you had a new continuous cough? (this means coughing a lot for more than an hour or three or more coughing episodes in 24 hours - if you usually have a cough, it may be worse than usual)

Have you lost sensations of taste or smell?

Have you had close contact (under 2 metres) with anyone with a confirmed Covid-19 diagnosis or someone exhibiting the above 3 symptoms in the last 14 days?

Have you recently travelled abroad and/or been instructed by the government to quarantine?

Have you been contacted by the government or NHS and told to self-isolate for any reason?

Do you fall under the clinically vulnerable category? 

Clinically vulnerable people are those who are:

  • aged 70 or older (regardless of medical conditions)
  • under 70 with an underlying health condition listed below (that is, anyone instructed to get a flu jab each year on medical grounds):
  • chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis
  • chronic heart disease, such as heart failure
  • chronic kidney disease
  • chronic liver disease, such as hepatitis
  • chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), or cerebral palsy
  • diabetes
  • a weakened immune system as the result of certain conditions or medicines they are taking (such as steroid tablets)
  • being seriously overweight (a body mass index (BMI) of 40 or above)
  • pregnant women


Do you live with someone who is in the clinically vulnerable category?

If you have answered YES to any of the above questions, do you consent to going ahead with this session or would you prefer to re-schedule? If you go ahead, you hereby indemnify me (Jane Collison) from any liability whatsoever.

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