Next Level Pilates COVID-19 Screening Questionnaire

Please complete this form on the day of your appointment (before entering Next Level Pilates).
 
Enter your name and today's date, then tick only the statements that apply to you. 

If you answer yes to any of the first 4 statements please call. Otherwise scroll to the bottom and tick "none of the above".

I am feeling UNWELL today OR have had cold or flu-like symptoms, including very mild symptoms associated with COVID-19 in the past 14 days.
I or a family/household member am awaiting a COVID-19 test result.
I have have been notified as being a "close contact" of a confirmed case of COVID-19 in the last 7 days
I have tested positive to COVID-19 in the last 14 days and/or continue to have respiratory symptoms following COVID -19 infection
I attest: