Kids Potential | COVID Health Check
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COVID Health Check

A COVID Health Check needs to be completed prior to any Face to Face appointments. 
If the form hasn’t been completed and received by Kids Potential prior to appointment then the appointment will be cancelled and a cancellation fee will be charged.
Please complete the form and click on the submit button below. If there is a “Yes” to any of the questions below, please contact your therapist regarding your COVID situation as soon as possible otherwise cancellation fees may apply.

Carer's Full Name*

Child's Name*

Email Address*

Mobile Number*

 Taylah Conley Donna Anderson

 Yes No

 Yes No

 Yes No