Holistic Hideaway - Massage in New Forest

Tel: 07793 532911

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Pre Treatment COVID-19 Form

Please complete and return this form before your treatment. Do contact me if you have any questions. Thank you.

Name(Required)
Symptoms(Required)
Do you currently have COVID-19 or any symptoms of COVID-19?

Please defer your treatment if you:

  • are waiting for a COVID-19 test result
  • have recently tested positive for COVID-19
  • have a high temperature, new continuous cough, or a loss or change to your sense of smell or taste
If you currently have symptoms of COVID-19 but have not yet had a test, please arrange one as soon as possible.

If you have any other new or unusual symptoms, please discuss these with your therapist before your appointment.

Have you had COVID-19(Required)
If you received medical treatment for COVID-19, please seek verbal or written consent from your GP or consultant before treatment.
Household(Required)
Does anyone in your household have COVID-19 or symptoms of COVID-19? If the answer is yes, please defer your appointment until they have 2 negative tests.
External contacts(Required)
Have you been in close contact with anyone outside of your household in the past 7 days who had or now has symptoms of COVID-19? If the answer is ‘yes’, please defer having a treatment for a further 5 days, unless you were wearing medical grade PPE (e.g. you are NHS staff or a healthcare professional).
Are you classed as extremely vulnerable?(Required)
If you meet the government’s definition of someone who is clinically extremely vulnerable, please discuss this further with me and it is advised that you seek verbal consent from your GP, midwife or consultant before having a treatment. If you are unsure if you are clinically extremely vulnerable, please refer to the NHS website at www.nhs.uk.

On the day of your treatment

On the morning of your treatment, if you have any Covid-19 or other flu/cold symptoms, please contact your therapist to defer your treatment.

Please ensure that you follow all procedures explained to you by your therapist, prior to treatment. Your therapist has carried out a full risk assessment and adheres to COVID-19 guidelines produced by the government and their professional association, the Federation of Holistic Therapists (FHT). For more information, visit fht.org.uk/coronavirus

Telephone: 07793 532911

Located at:
30a High Street
Lyndhurst SO43 7BG