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* 1. Name

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* 2. Email Address

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* 3. SYMPTOMS - Are you experiencing any of the following?

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* 4. Testing

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* 5. If you have had Covid are you still experiencing symptoms (long Covid)?

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* 6. Do you have any of the following health issues?

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* 7. Tick any of the boxes that apply to you.

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* 8. Our Governing Body's guidelines advise the use of gloves. However, it is not mandatory and the scientific evidence demonstrates that thorough hand washing is more effective in infection control for diseases such a Covid-19. Therefore if you would prefer us not to use gloves please tick this box.

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* 9. I sincerely declare that the information I have provided is true and correct.

If either I or someone I have been in contact with tests positive for Covid-19 or have been contacted by a tracing app I will inform you.

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