video-examples

COVID-19 screening form

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Would you like to visit to our store?

Due to Covid-19 we ask all customers to complete this form prior to your visit. Thanks for your understanding.

Start

How would you like to be contacted?

We may need to contact you to confirm your visit.

Phone

Email address

Phone

Have you travelled outside of the country in the last 14 days?

Yes

Has someone you are in close contact with tested positive for COVID-19 in the last 14 days?

Yes

Are you in close contact with a person who is sick with new respiratory symptoms or who recently traveled outside of the country?

Yes

Do you have a fever? (temperature ≥ 37.8°C)

Yes

Do you have any of these symptoms?

Chills

New or worsening cough

Shortness of breath/difficulty breathing

Sore throat

Runny or stuffy nose

Muscle aches

Loss of taste or smell

Headache that is unusual

Please contact us

We may be able to help you via email or on the phone.

Choose a prefered time slot

We will confirm your request within 48 hrs. We are open Monday-Friday, 9am to 5pm.

Morning

Afternoon

Date

This field should be left blank

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