Health Declaration Form
As per government directives, our dine-in guests are required to submit this form for contact-tracing purposes. Please provide accurate information.

We will politely decline service to those with Covid-19 symptoms and those who could have been exposed to potential cases. Thank you for your understanding.
I CERTIFY THAT:
• I have not had fever, cough, sore throat, loss of smell and taste, or difficulty breathing in the last 14 days.
• I have not had contact with a Covid-19 patient or anyone with the previous symptoms in the last 14 days.
• I have not traveled outside the Philippines in the last 14 days.
Name *
Mobile number *
Address *
Terms of Agreement *
Required
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