Below is my full Covid-19 protocol which you will receive this by email before your treatment. You can see what steps I’m taking to reduce risk below and you can also see what steps you need to take. I’ll contact you the day before your session to run through my ‘pre-screen’ questions. Working together we can reduce risks for all involved – and ensure that your session is relaxing and nurturing as always.


(valid Consent to Treatment Form and Notice of Risk Assessment)

Please read this consent form and if you wish to proceed with treatment sign where indicated at the end (you can do this on arrival at the clinic).  If you have received this form by email, please reply before your appointment to confirm you’ve read the information & you’ve said NO to all the pre-screen questions, and you’re happy to go ahead.   Equally, please indicate if there’s anything you wish to discuss with me.  If so we can talk on the phone before your session. 

If the treatment is for a child under 16years, the parent or legal guardian will complete and sign this consent form on the child’s behalf.

As a Craniosacral therapist I wish to limit the risk of transmission of Covid-19 for both you, myself, our families and community.   However, there is a risk of attending the clinic and/or receiving treatment.  

What I’m doing to reduce risk:

I’m taking extra precautions in line with current advice from the UK Government, Public Health England (PHE) and my Local Health Authority.  I’m rigorously following the guidelines laid out by my professional body, the Craniosacral Therapy Association (CSTA).   These include, but are not limited to: 

  • Pre-screening the suitability of all requests for treatment
  • Wearing appropriate PPE including facemask
  • Thoroughly sanitizing the clinic after each client – all surfaces, doorhandles, chairs, couch, loo
  • Ensuring gaps of 30 mins between clients (for airing, cleaning & to avoid you meeting other clients)
  • Rigorous hand-washing protocol before and after each client
  • All linens, blankets, soft toys etc removed from therapy room
  • Appointment times are strictly 45 minutes in length to limit contact time

Please can you:

  • Read and respond to this form before your treatment (I’ll email it to you a day or two before)
  • Arrive at the clinic wearing your own mask/face-covering (as stipulated by the Government) 
  • unless you’re exempt, in which case please inform me before your appt. 
  • Arrive on time for your appointment (& wait in car if you’re early)
  • Bring your own water and clean blanket for warmth if needed 
  • Wash/sanitize hands on arrival and on departure
  • Observe 2M social distancing whilst in the clinic, when not having treatment on couch
  • Bring correct cash (if using cash) and put in labelled box on table.  I’m also looking at getting a debit card machine. 
  • **MANY THANKS!**

 Pre-Screen for Coronavirus symptoms:

If you say YES to any of the following, please DO NOT attend your appointment:  (You can re-schedule when appropriate and won’t be charged a cancellation fee)    

In the last 7 days – have you started to get a new persistent cough?

In the last 7 days – have you started to get a temperature or fever?

In the last 7 days – have you started to notice you can’t smell or taste things properly?

In the last 14 days – have you been abroad? 

In the last 14 days – has a member of your household had symptoms of COVID-19?

In the last 14 days – Have you been in contact with someone with suspected/confirmed COVID-19?

Likewise, I also confirm that I am free of the symptoms and have not recently (within the last 14 days) been in contact with anyone that has.

NHS Test and Trace

I am required to assist NHS Test and Trace with requests for data (including name, contact number, dates and times of visit) if needed, up to 21 days after the treatment, as this could help contain clusters of outbreaks. NHS Test and Trace will ask for these records only where it is necessary, either because someone who has tested positive for COVID-19 has listed my premises as a place they visited recently, or because my premises have been identified as the location of a potential local outbreak of COVID-19.

If I get the call, I would have to disclose anyone I have been with for more than 15 minutes. As a result, depending on the circumstances and length of time that has elapsed, you might be asked to be tested, to take extra care with social distancing or to self-isolate. This is a risk that we would be taking in being in contact for sessions. 

The information given will only be used where necessary to stop the spread of Covid-19. 

You may opt-out if you do not want your details shared for the purposes of Test and Trace (by crossing out the relevant consent sentence below).

Levels of risk

I believe my practice has a robust risk assessment with enhanced procedures for face-to-face contact with most clients who are not at risk if they contract Covid-19.  However, for those who are in the ‘at risk’ groups (‘high risk: clinically extremely vulnerable’, or ‘moderate risk: clinically vulnerable’) the threshold for making a decision to provide care is set higher.  You are deemed to be ‘at risk’ if you are; 

High Risk – clinically extremely vulnerable

  • Have had an organ transplant  • are having chemotherapy or antibody treatment for cancer including immunotherapy  • are having an intense course of radiotherapy for lung cancer  • are having targeted cancer treatments that can affect the immune system  •have blood or bone marrow cancer  •have had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medication  • have been told by a doctor that they have a severe lung condition  • have a condition that means they have a very high risk of getting infections  •are taking medicine that makes them much more likely to get infections  •have a heart condition and are pregnant 

Moderate Risk – clinically vulnerable

 • Aged 70 + • Non-severe Lung condition (Asthma, COPD, Emphysema or Bronchitis) • Are pregnant   • Prone to Infections   • Heart disease, diabetes, chronic kidney or liver disease   • Neurological conditions (MS, Parkinson’s, MND or Cerebral Palsy)  • Take medicines that suppress the Immune System  • Obese (have a BMI of 40 or more)


You are strongly advised to read and discuss this document carefully with me, your therapist, and then make an informed consent on attending the practice. 


  • I have read and understood the foregoing Risk Assessment.
  • I confirm, to the best of my knowledge I am free of the symptoms of Covid-19 and have not recently been in contact with anyone who has. 
  • I understand that there is a risk of transmission of the coronavirus leading to Covid-19 (the disease) as a result of attending this practice and / or receiving treatment. 
  • I agree for my details to be shared with NHS Test and Trace should they request them within 21days of my appointment.
  • I agree, in the event that I develop symptoms of Covid-19 in the following 5 days after attending this practice, to inform the therapist of my changed status. This is to facilitate tracing anyone else who may have been potentially exposed to the coronavirus. I will only undertake do this in the understanding that the therapist maintains client confidentiality at all times.
  • I acknowledge I have discussed, or have been given the opportunity to discuss, with my therapist the nature of the contents of this consent.  I have had the opportunity to ask all the questions I wish to at this time and that all my questions were answered to my satisfaction.
  • I understand that I can choose to change my appointment to another date without incurring costs. 
  • I consent to the Craniosacral Therapy treatment offered or recommended to me today by my therapist. 

Name: ____________________________________________           _________________________________________________                 

(Please print name of client)                                                Client Signature 

Name: ____________________________________________           _________________________________________________

(Please print name of Therapist)                                     Therapist signature

  • Date (First Signing) : _____/ ___ / 20____ 

The following records re-confirmed understanding of Risk Assessment and Consent on subsequent treatment dates.

Re-confirmed understanding of Risk Assessment and Consent on subsequent treatment date(s), 

as previously signed:

Date and times of appointments:












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