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Meet the Team
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FAQs
Services
Physiotherapy
Sports Injury Clinic
Hand Clinic
Pelvic Health Clinic
Soft Tissue & Remedial Massage
Group Classes
Gait & Bike Assessment
Oncology Physiotherapy
Locations
Oxford
Summertown – Opening 1st June
University Club – Closed
Brookes University – Closed
Bicester – Opening 1st June
Woodstock – Opening 1st June
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ONLINE Classes
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Contact
Yoga
Follow us
About
Meet the Team
Prices
FAQs
Services
Physiotherapy
Sports Injury Clinic
Hand Clinic
Pelvic Health Clinic
Soft Tissue & Remedial Massage
Group Classes
Gait & Bike Assessment
Oncology Physiotherapy
Locations
Oxford
Summertown – Opening 1st June
University Club – Closed
Brookes University – Closed
Bicester – Opening 1st June
Woodstock – Opening 1st June
tops:health ONLINE
ONLINE Appointments
ONLINE Classes
ONLINE Shop
News & Events
Contact
Yoga
01865 311686
Follow us
Consent form COVID-19
Consent form COVID-19
We need you to complete this form prior to your face to face appointment.
Consent Form COVID -19
If you are human, leave this field blank.
Personal Details
Title
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First Name(s)
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Surname
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Face to Face Consent Form
I confirm that I have not had any of the following symptoms in the last 14 days: fever, shortness of breath, loss of sense of taste or smell, dry cough, runny nose or sore throat.
*
No
Yes
I confirm that I am not in the clinically extremely vulnerable category and therefore advised to shield by the government.
*
No
Yes
I confirm, to the best of my knowledge, I have not been in close contact with anyone with confirmed COVID-19 without wearing appropriate PPE.
*
No
Yes
I understand that coronoavirus may not cause symptoms in some people and is currently causing a pandemic which means healthcare services are required to operate differently.
*
No
Yes
I confirm that I am aware of the requirements for social distancing, hand sanitizing, wearing a face covering and for contactless payments, if able, when at the clinic.
*
No
Yes
I understand that the therapist/instructor will wipe down all surfaces before and after my attendance and they will be wearing PPE as set out by health authorities.
*
No
Yes
I am aware why my clinical need for healthcare cannot be met by a telephone or video consultation, and I have had the opportunity to ask all the questions I wish to and they have been answered to my satisfaction.
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No
Yes
I agree to attend a face to face appointment during the COVID-19 pandemic.
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No
Yes
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