Covid-19 Health Declaration
How are you feeling today?
Customer Name
Phone
Address
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
Service Date
I hereby authorize 1120 House and Omnivores Manila Inc., to collect my data indicated herein for the purposes of effecting control of the COVID-19 infection. I understand that my personal information is protected by RA 10173, Data Privacy Act of 2012.
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