HLB COUNSELLING

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!

ABOUT HLB COUNSELLING

Located in the heart of New Westminster, HLB Counselling offers counselling for individuals. Specialization in areas of: anxiety, children and youth, educational concerns, self-esteem, relational difficulties, family systems, trauma and spirituality.

CONTACT

3rd Floor, 321 6th St., New Westminster, B.C.

UPON REQUEST AFTER EMAIL CONTACT

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