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Slimming treatment
Platinum Luxury Treament
Intense Recovery Treatment
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COVID-19 Health Confirmation form
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/ COVID-19 Health Confirmation form
COVID-19 Health Confirmation form
Hygiene measures and a health check
Name
Email
Phone
Have you had one or more of the following (mild) complaints in the past 24 hours or at the moment: nose cold, cough, shortness of breath and / or fever (from 38 degrees Celsius)?
Yes
No
Do you currently have a housemate / family member with a fever and / or complaints of shortness of breath?
Yes
No
Have you had the new coronavirus (diagnosed with a laboratory test) and have you not yet been declared cured?
Yes
No
Do you have a roommate / family member with the new coronavirus (determined by a laboratory test) and did you have contact with this roommate / family member less than 14 days ago while he / she still had complaints?
Yes
No
Are you quarantined because you have had direct contact with someone who has been diagnosed with the new coronavirus?
Yes
No
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