Luxury Resort Tourist Medical Information Declaration Form
Personal Information
Full Name
Date of Birth
Nationality
Passport Number
Phone Number
Email Address
Emergency Contact
Contact Name
Relationship
Contact Phone
Contact Email
Medical Information
Do you have any allergies?
Yes
No
If yes, please specify:
Are you currently on any medication?
Yes
No
If yes, please specify:
Do you have any chronic medical conditions?
Yes
No
If yes, please specify:
Any recent surgeries, hospitalizations, or other medical issues we should be aware of?
Declaration & Signature
I hereby declare that the above information is true and complete to the best of my knowledge.
Signature
Date