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HE 011Please read and complete carefully Please note you can either fill this form out electronically and return by email to Rhonda northhavenhospice.org.NZ or PRINT out the form, complete and then

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How to fill out health declaration form

01

To fill out a health declaration form, follow these steps:

02

Start by providing your personal information, such as your full name, date of birth, and contact details.

03

Specify your current residential address and provide your travel history, including the countries you have visited recently.

04

Answer the questions regarding your health, including any symptoms you may be experiencing or any recent exposure to contagious diseases.

05

Declare any medications you are currently taking or any underlying medical conditions you have.

06

Finally, review the information you have entered and make sure it is accurate before submitting the form.

Who needs health declaration form?

01

Anyone who is required to travel, especially internationally, may need to fill out a health declaration form.

02

This can include travelers entering a particular country, passengers boarding a flight, or individuals attending events or gatherings.

03

Health declaration forms help authorities assess the risk of potential health issues and ensure the safety and well-being of both individuals and communities.

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What is health declaration form?

The health declaration form is a document where individuals disclose their current health condition and any recent travel history to prevent the spread of diseases.

Who is required to file health declaration form?

Anyone entering a certain country or attending a specific event may be required to file a health declaration form.

How to fill out health declaration form?

To fill out a health declaration form, individuals typically need to provide personal information, recent travel history, and current health status.

What is the purpose of health declaration form?

The purpose of the health declaration form is to monitor and manage the health status of individuals in order to prevent the spread of diseases.

What information must be reported on health declaration form?

Information such as personal details, recent travel history, and current health conditions must be reported on a health declaration form.

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