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info@newvitality.com.au

Health Declaration: Covid-19

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!

Write a Review

First Name

Last Name

Email

Phone

Rate Our Services

Excellent

Good

Room for Improvement

What did you like best?

How can we improve?

Would you recommend us to your friends?

Yes

No

Anything else you would like to add?

Thanks for submitting!

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