To keep us all as safe as possible it will be necessary for everyone to fill out a Covid-19 pre-treatment questionnaire.

I will email this to you 24 hours prior to your appointment. 

Here is an example of what this will include:

Please complete and return this form no more than 24 hours prior to your treatment and contact your therapist if you have any questions.


I will ask you...


Your name:


Date of treatment:


Type of treatment:


Do you currently have COVID-19 or any symptoms of COVID-19?

Yes☐ No☐


Please defer your treatment if you: are waiting for a COVID-19 test result; have recently tested positive for COVID- 19; or 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 used the NHS 111 online coronavirus service, please do so. If you have any other new or unusual symptoms, please discuss these with your therapist before your appointment.


Have you had COVID-19?

Yes☐ No☐


If you have had COVID-19, please seek verbal or written consent from your GP or consultant before treatment.


Does anyone in your household or support bubble have COVID-19 or symptoms of COVID-19?


Have you been in close contact with anyone else in the past 14 days who has symptoms of COVID-19, or been contacted by the NHS Test and Trace service and told to self-isolate?


If yes to either question, please defer seeing your therapist until it is safe to do so.


Are you classed as clinically extremely vulnerable or clinically vulnerable?

Yes☐ No☐


Are you currently shielding?

Yes☐ No☐


If yes, please defer treatments until you are no longer shielding.


If you meet the government’s definition of someone who is either clinically extremely vulnerable (high risk) or clinically vulnerable (moderate risk), please discuss this further with your therapist and seek verbal or written consent from your GP, midwife or consultant before having a treatment. (If you are unsure if you are clinically extremely vulnerable or clinically vulnerable, please refer to the NHS website at


Please check your temperature on the morning of your treatment. If it is higher than usual, or if you have any other symptoms, please contact your therapist to defer your treatment. Please ensure that you follow all new 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


Please note that if your therapist develops symptoms of COVID-19 and tests positive for the virus, your contact details may be shared with NHS Test and Trace (in line with GDPR/data protection), to help minimise the transmission of COVID-19 and support public health and safety.