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Summertown
Iffley Road
Bicester
Woodstock
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01865 311686
info@tops.health
About
Menu Toggle
Meet The Team
Pricing
News
Class Schedule
Physiotherapy
Menu Toggle
Physiotherapy
Sports Injuries
Pain & Injury
Pelvic Health
Oncology
Paediatric Physiotherapy
Hand Clinic
Clinical Pilates
Clinical Yoga
Vertigo
Home visits
Health & Performance
Menu Toggle
Sports Massage & Rehab
Gait Analysis & Orthotics
Biomechanical & Performance testingÂ
Shockwave
Body & Mind
Menu Toggle
Pilates
Yoga
Nutrition
Sports Massage & Rehab
Contact
Menu Toggle
Summertown
Iffley Road
Bicester
Woodstock
Book Online
Book Online
Book Classes
Book Classes
Main Menu
Consent form COVID-19
We need you to complete this form prior to your face to face appointment.
First Name
Last Name
Sur Name
I have not had any of the following symptoms in the last 7 days: fever, shortness of breath, loss of sense of taste or smell, dry cough, runny nose or sore throat and if I have, I have followed all government guidance.
False
True
To the best of my knowledge, I have not been in close contact with anyone with confirmed COVID-19 in the last 7 days, and if I have, I have followed all government guidance.
False
True
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.
False
True
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.
False
True
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.
False
True
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.
False
True
I agree to attend a face to face appointment during the COVID-19 pandemic.
False
True
If you answered no to any of the questions above, please provide detail:
Submit
About
Menu Toggle
Meet The Team
Pricing
News
Class Schedule
Physiotherapy
Menu Toggle
Physiotherapy
Sports Injuries
Pain & Injury
Pelvic Health
Oncology
Paediatric Physiotherapy
Hand Clinic
Clinical Pilates
Clinical Yoga
Vertigo
Home visits
Health & Performance
Menu Toggle
Sports Massage & Rehab
Gait Analysis & Orthotics
Biomechanical & Performance testingÂ
Shockwave
Body & Mind
Menu Toggle
Pilates
Yoga
Nutrition
Sports Massage & Rehab
Contact
Menu Toggle
Summertown
Iffley Road
Bicester
Woodstock
01865 311686
info@tops.health
About
Menu Toggle
Meet The Team
Pricing
News
Class Schedule
Physiotherapy
Menu Toggle
Physiotherapy
Sports Injuries
Pain & Injury
Pelvic Health
Oncology
Paediatric Physiotherapy
Hand Clinic
Clinical Pilates
Clinical Yoga
Vertigo
Home visits
Health & Performance
Menu Toggle
Sports Massage & Rehab
Gait Analysis & Orthotics
Biomechanical & Performance testingÂ
Shockwave
Body & Mind
Menu Toggle
Pilates
Yoga
Nutrition
Sports Massage & Rehab
Contact
Menu Toggle
Summertown
Iffley Road
Bicester
Woodstock
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If you have any questions please do not hesitate to contact us using the form below.
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Summertown
Iffley Road
Bicester
Woodstock
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