Risk of Coronavirus (COVID-19) Transmission at the Ananda Clinic.

*This Form is in addition to consent form for chiropractic examination and treatment*

The Government published a statutory instrument on 26th March 2020, no. 350 ‘The Health Protection (Coronavirus, Restrictions) (England) Regulations 2020’ confirming that it is lawful for a chiropractic practice to remain open. It further defines those who are recognised as vulnerable for the purpose of document.

The Ananda Clinic has conducted a thorough risk assessment to ensure adequate levels of saftly at this clinic are implemented and maintained. We are following the most up-to-date Government and Public Health England guidance and put in place stringent patient triage, hygiene, sanitation and infection control protocols to protect our patients staff/team members. Despite these precautions, there is a risk of transmission of the Coronavirus (CIVID-19) and it is important the you understand the risk. We have provided the information below to help you decide if you wish to continue with your care at The Ananda Clinic and remind you that you are under no obligation to do so.

Precautions that The Ananda Clinic has in place:

  • All patients contacting us for an appointment are triaged by a chiropractor over the telephone 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 on contact with anyone with COVID-19 symptoms.
  • We enforce a strict policy that anyone with any COVID-19 symptoms MUST stay away from the clinic.
  • A second triage is conducted at the clinic, including a temperature check.
  • A strict cleaning, sanitisation and infection control protocol is adhered to – Please ask if you would like to see this document.
  • All team members at The Ananda Clinic adhere to the social distancing guidance, wherever possible, issued by the Government. If social distancing cannot adhere: e.g. chiropractic treatment then both the chiropractor and the patient must wear appropriate PPE.
  • The layout of the practice has been adapted to maintain social distancing.
  • Please wait in your car until the time of your treatment, 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.

The Ananda Clinic is committed to ensuring that every measure is in place to minimise risk of exposure to COVID-19, we cannot guarantee there is no risk to you as a result of attending the clinic.

People can catch COVID-19 from others who have the virus. The disease can spread from person to person through small droplets from the nose or mouth which are spread when a person with COVID-19 coughs or exhales. These droplets land on objects and surfaces around the person. Other people then catch Covid-19 by touching these objects and surfaces, then touching their eyes, nose or mouth. People can also catch COVID-19 if they breathe in droplets from the person with COVID-19 who coughs our or exhales droplets.

The risk of catching COVID-19 from someone with no symptoms at all is very low. However, many people with COVID-19 experience only mild symptoms. This is particularly true at the early stages of the disease. It is therefore possible to catch COVID-19 from someone who has, for example, just a mild cough and does not feel ill. (World Health Organisation)

Eligibility for care

In addition to those with Covid-19 symptoms, self-isolating, living with someone with symptoms/self-isolating, or have been in contact with anyone with or suspected to have COVID-19, we are currently not accepting patients from the vulnerable “at risk” group defined below:

  • Pregnant
  • Over 70
  • Have a long-term health condition/Underlying Medical Condition 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 neuron 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 a condition 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.

Consent to receive care at The Ananda Clinic

  • I have answered all questions (triage) relating to my potential exposure to Coronavirus (COVID-19) truthfully.
  • I understand that there is a potential risk of transmission of Coronavirus (COVID-19) as a result of attending and/or receiving treatment.
  • I have had the opportunity to ask all the questions I wish to, and all my questions have been answered to my satisfaction.
  • I have read, agreed to and understood the statements above relating to Coronavirus (COVID-19) risk and consent to receive care at The Ananda Clinic.
  • I understand and agree that I will need to give separate consent regarding my chiropractic care.

Patient’s Name: __________________________________

Patient’s Signature: __________________________________

Date: __________________________________