Client / Patient Registration Form

Within the last two (2) weeks immediately preceding the date of this declaration,


I HAVE NOT:



tested positive or presumptively positive with the Coronavirus or been identified as a potential carrier of the COVID-19 virus

experienced any symptoms commonly associated with the Coronavirus

been in any location designated by the Australian Government as being hazardous and/or potentially infected with the Coronavirus

been in direct contact with or in the immediate vicinity of any person I know to be carrying the Coronavirus or has been identified as a potential carrier of the Coronavirus.