Health Check form

Covid-19 Questions

  • Please enter your full name
  • Are you, or is your family/partner, currently experiencing any of the following symptoms:
  • Have you had and/or recovered from the Covid-19/Corona disease in the last 14 days?
    If your answer below is 'Yes' or 'Maybe', please send us an email with details so we can assess your situation.
  • Are you part of a risk group?
  • Please inform us in case there are any important details we should know.
  • Please mark all 4 of the following statements, or contact us immediately in case you disagree with any of them.