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COVID-19 VIRUS STATEMENT

I am preparing to open for Business.

Please take the time to read the following information to ensure your safety, my safety and the safety of all my clients.

I will personally do my up most to reduce the risk of infection and/or transference of the COVID-19 virus. If you have been considered vulnerable and/or shielding (as per government guidance) – or in receipt of a GP letter, please contact me prior to your appointment on 07980929557 to discuss.
These are the steps I am taking:

1. Door handles and surfaces will be disinfected prior to the arrival of each client.
2. In between each client, I will be changing on arrival, couch, bedding and pillow cases.
3. I will be wearing a disposable mask during the treatment. Please ensure you will be doing the same. Please ensure you arrive with a disposable mask too.
4. Hand sanitizer will be provided prior to entry and exit of each treatment.

A form will be provided upon arrival. Alternatively, you may print one out beforehand. All clients will be required on each visit to complete and sign a short questionnaire prior to each treatment.

Click here to download the questionnaire.

 

CLIENT REQUIREMENTS UPON ARRIVAL

Clients are informed they will require the following on arrival:

1. A pen for COVID-19 Questionnaire form and signature
2. Complete the COVID-19 Questionnaire form prior to treatment where possible.
3. Two Towels – 1 Large Bath Towel and 1 Small Hand Towel
4. To be wearing a face mask on arrival. For your additional protection, please wear gloves.
5. Please refer to sharon.cummins.co.uk to refresh your understanding of the requirements for keeping us all safe.

Premises:

Squash Club: Please maintain social distancing (e.g. 2m space between each other) in accordance with the Squash Club guidance.
Barn: Please remain in your car until you receive a text from me that it is safe to enter.
I will be providing:

1. Fresh pillowcases for each individual client
2. Fresh bedding for each individual client
3. Hand sanitizer on arrival and departure.

Thank you for your time and patience whilst agreeing and complying with these new measures.

Sharon

COVID-19 VIRUS CLIENT QUESTIONNAIRE
Date:
All questions contained in this questionnaire are strictly confidential and will become part of your treatment notes.
Name (Last, First, M.I.):				M	F
Have you brought with you 1 large bath towel?				Yes	No
Have you brought with you 1 small hand towel?				Yes	No
Have you arrived with a mask?				Yes	No
Have you been provided with hand sanitizer?				Yes	No
Have you or anyone you have been in close contact with had any symptoms associated with COVID-19 within the last 14 days?				Yes	No
COVID-19 Virus ie:
High Temperature?				Yes	No
Hot to touch on back or chest?				Yes	No
A new or dry continuous cough which is persistent (no phlegm)?				Yes	No
A loss of, or change to, your sense of smell or taste?				Yes	No
Have you travelled or have had close contact with anyone who has travelled in the past 14 days?				Yes	No
Have you had close contact with anyone with respiratory illness or a confirmed or probably/suspected case of COVID-19?				Yes	No
Have you checked your temperature today?				Yes	No
Would you like me to check your temperature now?				Yes	No
Have you been strictly following social distancing measures as outlined by the Government?				Yes	No
Were you made aware of the requirements upon arrival prior to today’s appointment via text/voicemail message?				Yes	No
Are you considered clinically extremely vulnerable as per the letter from your GP?				Yes	No
Have you or anyone you have been in close contact with been advised to shield or considered at high risk under government guidelines or as per the letter from your GP.				Yes	No
Are you pregnant? If applicable.				Yes	No
Please check the boxes to acknowledge and agree:
I understand that my provider is taking many precautionary measures and these have been put into place and explained an abundance of caution. This is out of concern for the health and safety for our community. I understand that there is a risk of exposure.				Yes
I am aware of the risks of acquiring COVID-19 and I take full responsibility for my decision to receive in-clinic care.				Yes
I hereby confirm that the information above is true to my knowledge and would like to proceed with care on this basis.				Yes
In the event that you are not able to confirm the foregoing, I am happy to work with you to re-book your appointment for a later date.
Signature:______________________________________________Date:_________________