Traveller Accommodation Form - Ministry of Health, Wellness and Environment.

The following questions relate to your place of accommodation while in Antigua & Barbuda. Failure to fill and submit this form may result in delay upon arrival at the VC Bird International Airport.

Please contact 268-462-2675 or ehealth2015@gmail.com if there are any concerns related to this form.

Flight Number *

Example: AA2405

Name *

First

Middle

Last

Please indicate your official name as indicated on your Travel ID

Gender *

Male
Female
Other

Age *

Email *

Will you be staying in a hotel/AirBnB/guesthouse?* *

Hotel
AirBnB / Guesthouse
Private

Hotel Information *

Name of hotel you will be staying during your visit to Antigua & Barbuda

How many additional persons will be living/staying in the home? *

Single
1 - 4
5 - 10
>10

How many bedrooms are in the house? *

1
2
3
>3

How many bathrooms are in the house? *

1
2
>2

Select the age group(s) of person(s) living in the house (choose all that apply *

0-2
3-10
11-20
21-59
60+
none

Select whether anyone living in the home where you will be staying, has any of the following medical conditions *

Asthma
Cancer
Diabetes
Heart Disease
Hypertension
Immune Compromised Conditions
Sickle Cell Disease
NONE
Other

Specify

Message