Pilgrimage Health Declaration Form
Full Name
Passport/ID Number
Date of Birth
Gender
Male
Female
Other
Phone
Email
Address
Medical Information
Any chronic diseases (e.g. diabetes, hypertension)
Allergies
Current Medications
History of fever, cough, or respiratory symptoms in last 14 days?
No
Yes
Have you received all required vaccinations?
Yes
No
Other Health Information (optional)
Declaration
I hereby declare that the information provided is true and correct to the best of my knowledge.