Fit Again Sports Therapy COVID Screening

Please fill in the form below on the day of the appointment prior to every appointment.

Pre-appointment health screening

  • Have you tested positive for COVID-19 in the last 7 days?
  • Are you currently waiting for a COVID-19 test or the results to come back?
  • Do you currently have any of the following symptoms:
    • New, continuous cough?*
    • High temperature or fever?*
    • Loss of, or change in, sense of smell or taste?*
    • Unusually short of breath?
    • New abdominal pain or diarrhoea?
    • New blocked or runny nose?
    • Headache?
    • New unusual fatigue or muscle pain?
  • Do you live with someone who has either tested positive for COVID-19 or had symptoms of COVID-19 in the last 14 days?
  • Have you been notified by the Test and Trace in the last 14 days that you were a contact of a person who has tested positive for COVID-19 (someone you do not live with)?
  • Are you or anyone in your household currently self-isolating, shielding or classed in the high risk category? (e.g. severe respiratory condition, pregnant, taking immunosuppressive medication)
  • Have you travelled outside of the UK in the last 14 days?

(* Main COVID-19 symptoms)

Please also have a read through to ensure you are not in the high risk or extremely high risk categories to attend a face to face appointment.

High RiskExtremely High Risk
Aged 70 or olderHave had an organ transplant
Are pregnantAre having chemotherapy or antibody treatment for cancer, including immunotherapy
Have a lung condition that’s not classed as severe (such as, but not limited to, asthma, COPD, emphysema or bronchitisAre having targeted cancer treatments that can affect the immune system (such as protein kinase inhibitors or PARP inhibitors)
Have heart disease (such as heart failure)Have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma)
Have diabetesHave had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine
Have chronic kidney diseaseHave been told by a doctor they have a severe lung condition (such a, but not limited to, cystic fibrosis, severe asthma or severe COPD)
Have liver disease (such as hepatitis)Have a condition that means they have a very high risk of getting infections (such as, but not limited to, SCID or sickle cell)
Have a condition affecting the brain or nerves (such as, but not limited to, Parkinsons disease, motor neurone disease, multiple sclerosis or cerebral palsy)Are taking medicine that makes them more likely to get infections (such as high doses of steroids)
Have a condition that means they have a high risk of getting infectionsHave a serious heart condition and are pregnant
Are taking medicine that can affect the immune system (such as low doses of steriods)
Are very obese (a BMI of 40 or above)

Your Name (required)

Your Email (required)

I confirm that the answer is no to all of the above screening questions and I am not in the high or extremely high risk categories.