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SANDY
FEET
SIARGAO

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Covid-19 Health Declaration &
Antigen Consent Form

How are you feeling today?

First Name

Last Name

Email

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

I am not experiencing the symptoms: fever, cough, sore throat

I haven’t been in close contact with a Covid-19 patient in the last 14 days

Check-in date

Check-out date

Booking ID:

I am staying in Siargao for 5 Nights or more and agree to take an Antigen Test

How do you wish to pay for your Covid-19 Antigen Test. (Current price is P1400.00/test)

Room Charge (add 5% Service Charge)

I will pay in Cash direct to the Clinic

I declare that the info I’ve provided is accurate & complete

Thanks for submitting!

Malinao Tourism Road, Brgy. Malinao, General Luna

Siargao Island, Surigao del Norte, Philippines 8419

Cel. +63 962 040 5940

Cel. +63 966 177 5676 (WhatsApp)

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