Covid-19 Health Declaration

How are you feeling today?

First Name

Last Name

My body temperature this morning is lower than 98.6°F/ 37.5°C

I am not experiencing any of the following symptoms: sore throat, shortness of breath, headache and body aches, loss of appetite, weight loss, nausea, abdominal pain, vomiting, diarrhea, conjunctivitis, rash, swelling of the lymph nodes, apathy, somnolence.fever, cough, sore throat, lost of taste or smell or any other potential symptoms describe by the RKI institute.RKI Institute Symptoms Records

I have followed the governemental procedures uppon my arrival in Germany ( PCR test and / or quarantine), and I haven’t been in close contact with a COVID-19 patient in the last 14 days.Restrictions and Quarantine Regulations in Germany

Initials

Date

I declare that the informations I’ve provided are accurate & complete.

I accept terms & conditions

Thanks for submitting!