Covid-19 Measures Form - Hypnobirthing Home Visits Question Title * 1. Please provide your full names Name 1 Name 2 (if applicable) Name 3 (if applicable) Question Title * 2. What are the current occupations of all workshop attendees? 1 2 3 4 Question Title * 3. During the past 10 days have any attendees received a positive Covid-19 test result? No Yes Question Title * 4. In the past 10 days, have any attendees exerienced one or more of the following potential symptoms?Fever or chillsCoughShortness of breath or difficulty breathingFatigueMuscle or body achesHeadacheNew loss of taste or smellSore throat Yes No Question Title * 5. If the answer to Q3 above is 'yes', has the person(s) received a negative Covid-19 test result in the past 10 days? Yes No N/A Question Title * 6. Have any attendees been in contact with anyone who has tested positive for Covid-19 in the past 14 days? No Yes Question Title * 7. Are you able to provide an indoor space where Alice is able to sit at least 2m away whilst teaching? Yes No Question Title * 8. Optional space for comments or queries Done