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Health Declaration Form

Dear Sir/Madam

To prevent the spread of the Coronavirus (COVID_19) in our community and reduce the risk of exposure to our staff and visitors, we require you to complete this screening questionnaire prior to entering to our hospital premises.

Thank you.

Please enter N/A if not applicable

Describe if you selected others.



Dear Sir/Madam (Chinese)

To prevent the spread of the Coronavirus (COVID_19) in our community and reduce the risk of exposure to our staff and visitors, we require you to complete this screening questionnaire prior to entering to our hospital premises.

Thank you.

Please enter N/A if not applicable

Describe if you selected others.



Dear Sir/Madam (Bahasa Malay)

To prevent the spread of the Coronavirus (COVID_19) in our community and reduce the risk of exposure to our staff and visitors, we require you to complete this screening questionnaire prior to entering to our hospital premises.

Thank you.

Please enter N/A if not applicable

Describe if you selected others.



Dear Sir/Madam (Malay)

To prevent the spread of the Coronavirus (COVID_19) in our community and reduce the risk of exposure to our staff and visitors, we require you to complete this screening questionnaire prior to entering to our hospital premises.

Thank you.

Please enter N/A if not applicable

Describe if you selected others.