Mobility Authorization for Health Issues

New Coronavirus Infection - COVID-19

The Health Authority of the Autonomous Region of Madeira intends to monitor the risk associated with the disease by the new COVID 19. Therefore, we request your cooperation in completing this survey.

Personal information

Address and destination

Travel details

Reason

• Companion
COVID-19 Test
COVID-19 TESTS - Only tests for COVID-19 disease, performed in laboratories certified by national or international authorities, will be accepted in the 72 hours prior to disembarkation, with a negative result.
Epidemiological Data
Travel history or residence on areas with confirmed cases of COVID-19, in the last 14 days? *
Yes
No
Contact with a confirmed or probable case of SARS-CoV-2 ou COVID-19 infection in the last 14 days? *
Yes
No
Clinical Data
Fever or cof or respiratory difficulty? *
Yes
No

Declarations and authorizations

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