Attendance Declaration


Attendance Declaration

At Pure Health Chiropractic & Wellness, we make a commitment to your health and believe that every individual has a right to fulfil their health potential. We will always aim to provide a professional and courteous service aimed at helping you achieve and maintain good health. In return, we ask that you make a commitment to your care by keeping appointments, following advice and by communicating openly with your practitioner.

Please note that if you fail to arrive for any of your appointments or if you give us less than 24 hours notice of cancellation, we reserve the right to charge a fee or keep any pre-payment.

We ask that you please:

  • Arrive on time for your appointment and wait in reception if available.
  • Wait for your clinician to come and collect you when ready
  • Wear clothes that are comfortable and ready for treatment.
  • Sanitise your hands using the hand gel on entering the building.
  • Attend on your own, unless under 16 or require a chaperone.

​Our general clinic policies are available here:

Illnesses and Covid-19

If you have ANY current illnesses or feel unwell, including Covid symptoms (found at, then please DO NOT attend and reschedule your appointment.

​Mask wearing and PPE use is no longer mandatory, but is risk-assessed on a case by case basis. Our practitioners will continue to wear masks, however it is not currently mandatory in a healthcare setting. To keep everyone safe, strict infection prevention control measures are still in place.

I confirm that I do NOT have any current symptoms of illness * This question will be required

Attendance Declaration

By signing below, you are accepting the following statements: (in the case of a child, or a person of diminished intellectual capacity, parent/guardian to sign)

  • ​Some staff members, as well as some patients attending this practice, might not be Covid vaccinated due to ineligibility, medical contraindications/ exemptions or personal preference.
  • I understand Pure Health Chiropractic cannot accept responsibility for transmission of any illness (including Covid-19).
  • I understand and accept all the statements on this form.
  • I will be attending my appointment.