COVID-19 Safe Entry Survey

Full Name:

Full Name

NRIC / FIN:

NRIC / FIN

Mobile Number:

Mobile Number

Therapist:

Therapist Name

Temperature:

Temp Number

Please SHOW your therapist your inputs above.

DISCLOSURE:

By submitting this information you confirm that:

• your name, NRIC and mobile number submitted here are true, current and complete

• you have not travelled anywhere outside Singapore any time in the last 2 weeks

• you are experiencing no symptoms such as: cough, fever, runny nose or sneezing

• you have not been in contact with any confirmed COVID-19 cases

• you are currently NOT on quarantine orders