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Covid-19 Health Declaration &
Antigen Consent Form
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
Check-in date
Check-out date
Booking ID:
I am staying in the island for 5 and agree to take an Antigen Test Nights or more
Mode of Payment. How do you wish to pay for your Covid-19 Antigen Test? Current Price is P1,400/test
*
Room Charge (add 5% Service Charge)
I will pay in Cash direct to the Clinic
I declare that the info I’ve provided is accurate & complete
Submit
Thanks for submitting!
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