covid | AS2M

Mon - Fri: 09:00am - 5:00pm

Sat & Sun 09:00am - 12:00pm

Easter, Christmas & Boxing Day closed

0476 029204

Home
Services
Book Online
Shop
More...

Office Meeting

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

©2020 Proudly created by Dobbie Tipene Services. All Rights Reserved.