Screening Form

Have you returned from a country classified with having a "High Risk" exposure to COVID 19 in the last 7 days?*

Do you have a persistent cough or temperature?*

Do you have any change or loss to your sense of smell or taste?*

Have you been in contact with anyone who has COVID-19 symptoms in the last 72hrs?*

Have you been asked to self-isolate?*

Do you consider yourself to be high risk to Covid 19, or classed as Immunosuppression ?*

Do you or have you worked in a front line role which may have brought you into contact with COVID -19?*

Have you had Covid-19 Vaccination or Booster?*

I will inform The Body Retreat if I show any symptoms of Covid with in 14 days of leaving the Retreat.*

If you have answered "Yes" to any of the above question then we will contact you.

Full Name

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Today's Date

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