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Before treatments in the clinic or attending a training course you must agree to the following: 


I understand that I am opting for an elective medical treatment/procedure or attending a training course at my own will. 


I understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organisation and that COVID-19 is extremely contagious and is believed to spread by person-to-person contact; and, as a result, social distancing is recommended. I Understand that this is not entirely possible with my proposed treatment or course; however, I am satisfied that safety measures are in place to minimise risk as much as possible, and patient contact will be kept to an absolute minimum in line with medical need.


I understand the Management and Clinical Staff are closely monitoring the COVID-19 situation and have put in place reasonable preventative measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with treatment or training. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this elective medical treatment/procedure or training and I give my express permission to proceed. 


I understand the COVID-19 virus has a long incubation period (14 days) during which carriers of the virus may not show symptoms and still be highly contagious. I understand that COVID-19 can cause additional health risks, some of which may not currently be known at this time, in addition to those risks associated with the medical treatment/procedure itself. 


I have been given or can ask for the option to defer my medical treatment/procedure or training course to a later date. However, I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to proceed with my desired medical treatment/procedure or training course. 


You must confirm that you are not suffering with any of the following symptoms of COVOID-19 listed: 


o   fever

o   shortness of breath

o   loss or change of sense of taste or smell

o   dry cough

o   sore throat


You must also confirm that: 


o   people I live with have none of the symptoms listed above

o   I or anyone I live with have not been asked to isolate through a Track & Trace system


29 High Street, Swallownest, Sheffield, S26 4TT

07482 560095

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