Health Screening Form

Subject
Health Screening Form

Name

Contact Email

Phone

Emergency Contact Details

Are you over 18?
YESNO
Are you suffering from high blood pressure?
YESNO
Do you have a condition that is adversely affected by heat?
YESNO
Are you pregnant? (If yes, you must be in the second trimester and run a cooler bath)
YESNO
Have you ever been diagnosed with heart disease, stroke or had a heart attack? (If yes, please run your bath cooler)
YESNO

Please note that seaweed is a natural product that is collected from the seashore, cleaned and treated but still may contain some stones and shells of crustaceans.

I state that all of the above questions are answered correctly and to the best of my knowledge and that I have filled out the Covid-19 form online.

Signed

Date

Would you like to receive information regarding opening times/offers/competitions etc?
YESNO
If you answered yes, how would you like to receive this information
TextEmailPost
If Post, please provide your postal address