Pre-Treatment COVID Screening Questionnaire
www.stressproject.org.uk

To keep everyone safe during the pandemic, Stress Project clients are required to complete this questionnaire prior to treatment. We assure you that the information you provide remains confidential unless we are legally bound to release it.
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Name *
 Today's Date *
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Are you currently experiencing any symptoms of COVID-19? *
Are you, or anyone in your household or amongst your close contacts, experiencing any of the following symptoms which have suddenly become apparent (tick those that apply)
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If you have answered yes, you should not attend your appointment at The Stress Project and limit your contacts in line with NHS recommendations.
Do you agree to contact the Stress Project if you  develop symptoms associated with COVID-19 within 7 days of your treatment? *
The Stress Project has COVID-19 prevention measures in place to keep you and everyone safe. Wash your hands before and after your treatment. Wear a face mask if you can. Keep your distance. Bring your own water bottle. Arrive at your appointment time, no waiting area at the centre.
Privacy Statement: Holloway Neighbourhood Group is GDPR compliant. Our full privacy statement can be found at www.stressproject.org.uk/privacy 
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