*This form is in addition to consent form for your balance treatment, therapy or class* Balance has conducted a thorough risk assessment to ensure adequate levels of safety in the centre are implemented and maintained. We are following the most up-to-date Government and Health Protection Scotland guidance and put in place stringent patient triage, hygiene, sanitation and infection control protocols to protect our patients / clients and team members. Despite these precautions, there is a risk of transmission of the Coronavirus (COVID-19) and it is important that you understand the risk. We have provided the information below to help you decide if you wish to continue with your care at Balance and remind you that you are under no obligation to do so. Precautions that Balance has in place: All patients contacting us for an appointment have to satisfy a Level 1 remote triage to establish whether symptoms are present, if they are self-isolating, if anyone in their household has symptoms or is self-isolating, or they have been in contact with anyone with COVID-19 symptoms. We enforce a strict policy that anyone with any COVID-19 symptoms must stay away from Balance. A second triage is conducted at Balance, including temperature check. A strict cleaning, sanitation and infection control protocol is adhered to – Please ask if you would like to see this document. All team members at Balance adhere to the social distancing guidance issued by Government. The layout of the practice has been adapted to maintain social distancing. Patients waiting are restricted to one at any time and a 2-metre distance will be enforced between patients and non-clinical team members. Chiropractors and Clinical staff will be wearing Personal Protective Equipment for your protection. Balance is committed to ensuring that every measure is in place to minimise the risk of exposure to COVID-19, however, we cannot guarantee there is no risk to you as a result of attending the centre. Eligibility for Care In addition to those with COVID-19 symptoms, those self-isolating, those living with someone with symptoms and/or self-isolating, or those who have been in contact with anyone with or suspected to have COVID-19; we may not be accepting patients from the vulnerable “at risk” groups defined below: Pregnant Aged 70 or over Having a long-term health condition / Underlying Medical Conditions as listed below: Chronic (long-term) respiratory diseases, such as asthma, chronic obstructive pulmonary disease, emphysema or bronchitis. Chronic heart disease, such as heart failure. Chronic kidney disease. Chronic liver disease, such as hepatitis. Chronic neurological conditions such as Parkinson’s disease, motor neurone disease, multiple sclerosis, a learning disability or cerebral palsy. Diabetes. Problems with the spleen, such as sickle cell disease or removal of the spleen. A weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets or chemotherapy. Being seriously overweight, with a body mass index of 40 or above.

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