Reflexology By Niamh Holistic Therapies Covid-19 Pre-Consultation Form Logo

  • Covid-19 Pre-Consultation Form

    To help prevent the spread of Covid-19 in the clinic and the local community, each client must complete and sign this form before attending for treatment. On review of the form, I may contact you to discuss. NB - EVERY QUESTION MUST BE ANSWERED. I kindly ask that you compete and return the form at least 12 hours in advance of your treatment. Together we can help keep everyone safe! Thank you.

  • I consent to my contact details being held on record and shared, if asked, with HSE personnel for the explicit purpose of contact tracing in respect of COVID-19, as required by current government guidelines.

  • I agree not to visit the treatment room for any of the services provided if I have the symptoms of COVID-19. I acknowledge that the information I have given in this consent form is accurate and complete. By signing below, I confirm that I understand and agree to all terms and statements in this form.

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