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Health declaration form
All fields are required.
NB: It is an offence under the Infectious Diseases Act to provide false declaration.
Have you been diagnosed with COVID-19 in the last 7 days?
Yes
No
Do you have any of the following symptoms:
No
Fever
Cough
Shortness of breath
Runny nose
Sore throat
Did you have contact with any case of COVID-19 in the last 7 days?
Yes
No
Name as in NRIC
Acknowledgement:
I acknowledge that I’ll turn up for my appointment unaccompanied. Only one accompanying adult will be allowed for minors.
...
Declaration:
I hereby declare that I have answered the above questions truthfully.
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