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Tan Son Nhat Golf Course

(+84) 94 666 0088

(+84) 283 987 6666

MEDICAL DECLARATION FORM (For customers)

Medical declaration:

If you have any of the followings at present or during the past 21 days (until the date of check in at Long Bien Golf course)?
Symptoms Yes No
Fever (*)
Cough (*)
Shortness of breath (*)
Sore throat (*)
Symptoms Yes No
Sneezing, runny nose (*)
Fatigue (*)
Vomiting / nausea (*)
Diarrhea (*)
History of exposure: During the last 21 days (until the date of check in atLong Bien Golf course), did you:
Yes No
Contact with people directly caring for people with Covid 19 (*)
Contact with people from abroad (where there is the Covid epidemic) returning (*)
* Contact with an infected or suspected person with Covid 19 (F0, F1, F2, F3) (*)
Contact with suspected person with fever,cough, shortness of breath, pneumonia (*)
Have been contacting social distancing areas (living/going through/contacting with those who pass a high volume of positive cases such as Hai Duong, Hanoi, Quang Ninh, Gia Lai, Bac Ninh...) (*)

I hereby declare that the above information is true and understand that providing false information may lead to serious consequences.