Next Level Pilates COVID-19 Screening Questionnaire

To ensure Next Level Pilates remains a safe place for all, 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 below that apply to you. 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 had contact with a confirmed case of COVID-19 or someone in isolation/quarantine in the last 14 days.
I have travelled on an airplane in the past 14 days OR visited a public exposure site as listed by the Victorian DHHS.
I attest: