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COVID-19 Questionnaire
The Mind Body Practice collects limited personal information from visitors to the facilities for risk and screening purposes in accordance with Public Directions/Orders. Collection of personal information for this purpose will be managed in accordance with Public Directions/Orders and the Privacy Policy, a copy of which is available at
https://www.mindbodypractice.com.au/privacypolicy
or upon request.
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* Indicates required question
Email
*
Your email
Full Name
*
Your answer
Mobile Number
*
Your answer
Are you attending with children?
*
Yes
No
Where you live (enter postcode)
*
Your answer
Where you work (enter postcode)
*
Your answer
Are you currently in a period of self-isolation following a positive COVID-19 test
*
Yes
No
Have you been in close contact with a confirmed COVID-19 case in the past 14 days?
*
Yes
No
Have you been formally identified as a close contact of a confirmed case?
*
Yes
No
Are you unwell with any cold or flu like symptoms including: fevers, cough, vomiting, diarrhoea, night sweats or chills, or acute respiratory infection including cough, shortness of breath or sore throat?
*
Yes
No
Have you travelled to an identified hotspot as identified here (
https://www.nsw.gov.au/covid-19/latest-news-and-updates#latest-covid-19-case-locations-in-nsw
) in the last 14 days?
*
Yes
No
Have you returned from Victoria, overseas or from a cruise in the last 14 days?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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