Norris Health Pre face-to-face appointment Physiotherapy screening


    Please tick yes if you have any of the following

    Symptom

    A fever (a temperature over 37.8 degrees centigrade)

    YesNo

    New or worsening persistent cough

    YesNo

    Shortness of breath

    YesNo

    Loss of the sense of smell or taste

    YesNo

    Difficulty breathing

    YesNo

    Chills or body aches

    YesNo

    Headaches or sore throat

    YesNo

    Diarrhoea or vomiting

    YesNo








    Declaration:

    I solemnly and sincerely declare that the information I have provided is true and correct and
    I make this solemn declaration conscientiously believing the same to be true. If any person
    should suffer as a result of the information being found to be untrue or false, then I am
    aware that I can be prosecuted for making a false declaration.

    I confirm that the above information is accurate

    Consent to receive Physiotherapy care at Norris Health

    • I have answered all questions relating to my exposure to Coronavirus (COVID-19) truthfully.

    • I understand that there is a potential risk of transmission of Coronavirus (COVID-19) as a
      result of attending the clinic and/or receiving treatment.

    • I have had the opportunity to ask all the questions I wish to, and all of my questions have
      been answered to my satisfaction.

    • I have read, agreed, and understood the statements above relating to Coronavirus
      (COVID-19) risk and consent to receive Podiatry care at Norris Health

    I confirm that the above information is accurate


    Has this patient had a remote physiotherapy consultation (triage)?

    YesNo

    NORRIS HEALTH ACQUIRED BY CARTER & GEORGE

    The Carter & George Practice look forward to building on the excellent reputation of Norris Health, and are committed to ensuring minimal disruption in your care.

    For details of Dr Chris Norris’ courses, publications and consultancy see his new website Dr Chris Norris.

    We are very proud to announce that Norris Health has been acquired by The Carter & George Practice, co-owned by England Rugby International, Jamie George.

    To find out more about The Carter & George Practice, please click here.

    To book an appointment in Congleton, please call 01260 290564 or email help@carterandgeorge.co.uk
    We look forward to seeing you soon.

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