Digital Nomad Visa Health Form
Full Name
Date of Birth
Passport Number
Nationality
Email Address
Contact Number
Current Address
Health Insurance Provider
Policy Number
Do you have any pre-existing medical conditions?
No
Yes
If yes, please specify
Current Medications
COVID-19 Vaccination Status
Fully Vaccinated
Partially Vaccinated
Not Vaccinated
Name of Primary Care Physician
Physician Contact Number
Additional Health Information