yOU NEED TO BRING YOUR ORGINAL PASSPORT WITH YOU

– iF YOU WOULD LIKE TO MAKE THE BOOKING PROCESS EASIER YOU CAN email A COPY OF YOUR PASSPORT TO US BEFORE YOUR BOOKING DATE

Please note: A certified copy of your passport will not be accepted – contact INZ  for more information

You will be asked these questions on your arrival at our clinic

COVID-19 SCREENING QUESTIONNAIRE

Have you been fully vaccinated ..…………….……………………..¨Yes/No

• If NO please call us to confirm your booking

Have you left MIQ within the last week? ……………………… ¨Yes/No

• If YES please call us to confirm this booking

Have you travelled from an area with active COVID
cases in the last two weeks?…………………………………………. ¨Yes/No

• If YES please call us to confirm this booking

Have you been in close contact with someone unwell
with respiratory symptoms or fever, or are suspected
or confirmed to have COVID-19 in the past 2 weeks? …… ¨Yes/No

• IF YES please call us to confirm this booking

Do you have any of the following?  If YES please call us to confirm this booking

• a cough…………………………………………………………………… ¨Yes/No
• any trouble breathing……………………………………………… ¨Yes/No
• sore throat………………………………………………………………. ¨Yes/No
• sneezing or runny nose……………………………………………. ¨Yes/No
• loss of taste or smell……………………………………………….. ¨Yes/No

 WEAR A MASK AT ALL TIMES

admin@lifeclinic.co.nz