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Heaney & Mill - Track & Trace

In order for us to comply with Government regulations, please fill out the following form in order to dine at Heaney & Mill.

First Name

Last Name

Email

Phone

I have not knowingly been in contact with anyone who has tested positive for COVID-19 in the last 14 days.

Are you experiencing any COVID-19 symptoms?

No

Yes

Date

Initials

I confirm that the information given in this form is true

Thanks for submitting and helping us keep everyone safe.

50 Otley Road

Headingley

Leeds

England

United Kingdom

LS6 2AL

0113 278 1640

© 2021 Heaney & Mill