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Covid-19 Patient Declaration

This form tells you about the precautions we’re taking. Please complete it before you visit for Chiropractic, Massage therapy and other treatments carried out at Central chiropractic Clinic.

What we’re doing to protect you:

  • Everyone who comes here must wash their hands on arrival and follow our safety protocols.
  • We’ve reduced the number of appointments to allow for social distancing.
  • There’s a wash basin in every room with anti-bac soap strong enough to kill Covid-19.
  • We’re keeping doors open to keep the air flowing.
  • We’ve adapted our reception to allow for social distancing, protecting you and our team.

What else your chiropractor is doing:

  • Your chiropractors are up to date with all the latest PPE.
  • They’re washing their hands, dis-infecting the bench and cleaning anything you’ve touched in the room with every treatment.
  • The chiropractors are considering everyone’s case individually and when needed they’re taking extra action to keep you extra safe (call in advance if you have any concerns).
  • NHS advice for people at high-risk

Remote treatment and advice:

  • We’re promoting remote-treatment and self-help.
  • We’ve been carrying out telephone or video assessments which have proven very popular and we’ve written lots of self-help blogs available at:

What you need to do:

  • Review our posters when you arrive, and then thoroughly wash your hands.
  • Bring a freshly laundered towel to your appointments.
  • Please don’t arrive early or bring unnecessary people with you.
  • Sit 2m apart in reception and keep 2m form receptionists.
  • Avoid touching things unnecessarily when you’re at the clinic.
  • Speak to your chiropractor or massage therapist before coming if you should be “shielding”.
  • Consider your personal risk factors before coming (e.g. aged 70 plus).

Do not come if you or anyone you live with has symptoms:

  • High temperature – your chest or back feel hot (you don’t need to measure your temp)
  • New, continuous cough – coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
  • Loss or change of smell or taste

Then do not come in and make sure you’re Self Isolating according to Government Guidance.

Consider the risks:

In some cases of Coronavirus (Covid-19) the symptoms and complications are severe or even fatal. The safest place during this pandemic is at home. Whenever you leave your home you increase the risk of catching Covid-19. Please reflect on this before coming.

People at higher risk should have had a letter from the NHS asking them to “shield” for 12 weeks, for example you’ve had an organ transplant or are on chemotherapy. If this is you then you must speak to your chiropractor or massage therapist before coming in.

There’s also a large group of people who are at moderate risk from coronavirus. These are:

  • Are aged over 70
  • Are seriously overweight with a BMI of 40 or above (check at home if unsure)
  • Have a long-term lung condition (such as COPD, bronchitis or emphysema)
  • Have chronic heart, kidney or liver disease
  • Have diabetes
  • Have chronic neurological conditions (e.g. Parkinson’s, motor neurone disease or MS)
  • Have problems with your spleen (e.g. sickle cell)
  • Have a weak immune system (e.g. HIV, AIDS, steroids, immunosuppressants or chemotherapy)
  • Are pregnant

Covid-19 consent:

By signing below, I confirm that:

  • I understand and agree to follow all the statements on this form
  • I have considered the risk of transmission of Coronavirus as a result of attending the clinic and would like to attend
  • I understand that Lushington Chiropractic has taken reasonable steps to prevent Covid-19 transmission at the Clinic, but they cannot guarantee that this will not happen during my visit to the clinic.

By digitally signing below, I confirm that:

Digital Signature

I accept the terms and conditions laid out on this Covid-19 self-declaration form

Date format YYYY-MM-DD format (e.g. 2020-01-01)

Clicking Send will send a copy of this form to the team and you will receive a copy to the email address provided.

Your Thoughts Matter

Let us know what you think about our services. Your feedback is always valued as it helps us improve our practice so that we can offer the top quality services for you and your needs.

Please spare just a moment of your time to share your thoughts.