Admission Form Testing

Nimba Nature Cure Village

Admission Form




    Guest History

    1. Have you undergone any surgery in recent years?

    2. Do you suffer from any kind of infectious Disease or skin disease?

    3. Do you suffer from any heart disease or undergone angioplasty / bypass / open-heart surgery in the past?

    4. Do you suffer from any type of Kidney / Liver / Lung Disease?

    5. Are you physically or visually disabled in anyway?

    6. Can you walk 1 km without support?

    7. Details of addiction if any (Please tick mark accordingly)