Covid-19 Form | The Recovery Hub

top of page

Use tab to navigate through the menu items.

Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

Email

My body temperature is lower than 98.6°F/ 37.5°C

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Initials

Date

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

First Name

Last Name

Email

Subject & Contact Number

Message

Thanks for submitting!

The Junction Sports & Leisure Centre,

Station Approach,

Broadstone,

Poole,

Dorset,

BH18 8AX

Tel: 07544 281 283

MENU

SOCIALS

bottom of page