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DR
CLEAN
Singapore
Covid-19 Health Declaration
How are you feeling today?
First Name
Last Name
Phone
My body temperature is lower than 98.6°F/ 37.5°C
I am not experiencing the symptoms: fever, cough, Chills, Repeated shaking with chills , Muscle pain , Headache , Sore throat New loss of taste or smel
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
Submit
Thanks for submitting!
Agreement
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