Health Screening Form

Name *

Email *

Phone Number *

Emergency Contact Details *

Are you over 18? *

Are you suffering from high blood pressure? *

Do you have a condition that is adversely affected by heat? *

Are you pregnant? (If yes, you must be in the second trimester and run a cooler bath) *

Have you ever been diagnosed with heart disease, stroke or had a heart attack? (If yes, please run your bath cooler)

Covid Compliance *

I do not have symptoms, nor have I been in contact with anyone who has tested positive with Covid 19 in the last 24 hours.

If you answered yes to any of the above, please elaborate

Final Disclaimer *

I state that the above questions are answered correctly and to the best of my knowledge