top of page
YING ZHANG
Acupuncture & Chinese Medicine
H O M E
P H I L O S O P H Y
C O N T A C T
Registration Form
T E S T I M O N I A L S
More
Use tab to navigate through the menu items.
Covid-19 Free Declaration
Full Name
Email Address
Contact Phone for Track & Trace
My body temperature is lower than 98.6°F/ 37.5°C. high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
Have you had a Persistent Temperature, Dry Cough, Loss of Taste/Smell or been in contact with anyone with Covid symptoms or diagnosis in the last 14days?
No
Yes
Have you travelled within the last 2 weeks from ”high risk” countries which are not in the government travel corridor list?
No
Yes
Have you been told to self Isolate, Quarantine or are you Shielding at the moment?
No
Yes
I confirm that I am happy to comply with NHS track and trace and satisfied with the Covid-19 Safety Protocols in place at this premises.
Date
Submit
bottom of page
