{"id":8889,"date":"2023-02-23T03:43:17","date_gmt":"2023-02-23T03:43:17","guid":{"rendered":"https:\/\/kurresortlanka.com\/?page_id=8889"},"modified":"2026-02-20T10:07:21","modified_gmt":"2026-02-20T10:07:21","slug":"medical-declaration-form","status":"publish","type":"page","link":"https:\/\/www.kurresortlanka.com\/de\/medical-declaration-form\/","title":{"rendered":"GESUNDHEITSFRAGEBOGEN"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"8889\" class=\"elementor elementor-8889\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3443b79 elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile elementor-section-boxed elementor-section-gap-beside-yes elementor-section-height-default elementor-section-height-default elementor-section-column-vertical-align-stretch\" data-id=\"3443b79\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-abb6d53\" data-id=\"abb6d53\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e973cd2 elementor-widget elementor-widget-button\" data-id=\"e973cd2\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"#\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"far fa-arrow-circle-left\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Back to Home<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1aaaef3 elementor-section-boxed elementor-section-gap-beside-yes elementor-section-height-default elementor-section-height-default elementor-section-column-vertical-align-stretch\" data-id=\"1aaaef3\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-extended\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-dccbf54\" data-id=\"dccbf54\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6f6904a elementor-widget elementor-widget-image\" data-id=\"6f6904a\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"https:\/\/kurresortlanka.com\/\">\n\t\t\t\t\t\t\t<img decoding=\"async\" width=\"180\" height=\"120\" src=\"https:\/\/www.kurresortlanka.com\/wp-content\/uploads\/2023\/01\/kur-resort-logo-1.png\" class=\"attachment-large size-large wp-image-7350\" alt=\"kur resort lanka am see\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-007c3f8 elementor-invisible elementor-widget elementor-widget-heading\" data-id=\"007c3f8\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInUp&quot;}\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">MEDICAL DECLARATION FORM<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-66a910b elementor-button-align-start elementor-invisible elementor-widget elementor-widget-form\" data-id=\"66a910b\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;_animation&quot;:&quot;fadeInUp&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"New Form\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"8889\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"66a910b\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-firstname elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-firstname\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFirst Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[firstname]\" id=\"form-field-firstname\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-Lastname elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-Lastname\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[Lastname]\" id=\"form-field-Lastname\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-Gender elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-Gender\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMale \/ Female\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Male\" id=\"form-field-Gender-0\" name=\"form_fields[Gender]\"> <label for=\"form-field-Gender-0\">Male<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Female\" id=\"form-field-Gender-1\" name=\"form_fields[Gender]\"> <label for=\"form-field-Gender-1\">Female<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-Age elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-Age\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAge\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[Age]\" id=\"form-field-Age\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" min=\"\" max=\"\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-dateofbirth elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-dateofbirth\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDate of Birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[dateofbirth]\" id=\"form-field-dateofbirth\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-PassportID elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-PassportID\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t Passport\/ID Number *\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[PassportID]\" id=\"form-field-PassportID\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-date elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-date\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tArrival Date\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[date]\" id=\"form-field-date\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-number elementor-field-group elementor-column elementor-field-group-Contact elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-Contact\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tContact Number (Include with country code)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t<input type=\"number\" name=\"form_fields[Contact]\" id=\"form-field-Contact\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" min=\"\" max=\"\" >\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-Address elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-Address\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAddress\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[Address]\" id=\"form-field-Address\" class=\"elementor-field elementor-size-sm  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-Country elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-Country\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tCountry\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[Country]\" id=\"form-field-Country\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Germany\">Germany<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Afghanistan\">Afghanistan<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Albania\">Albania<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Andorra\">Andorra<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Angola \">Angola <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Antigua and Barbuda \">Antigua and Barbuda <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saudi Arabia Algeria \">Saudi Arabia Algeria <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Argentina \">Argentina <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Armenia \">Armenia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Australia \">Australia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Austria \">Austria <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Azerbaijan \">Azerbaijan <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bahamas \">Bahamas <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bangladesh \">Bangladesh <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Barbados \">Barbados <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bahrain \">Bahrain <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Belgium \">Belgium <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"elize \">elize <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Benin \">Benin <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Belarus \">Belarus <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Burma \">Burma <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bolivia \">Bolivia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bosnia and Herzegovina \">Bosnia and Herzegovina <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Botswana \">Botswana <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Brazil \">Brazil <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Brunei \">Brunei <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bulgaria \">Bulgaria <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Burkina \">Burkina <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Faso \">Faso <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Burundi \">Burundi <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Bhutan \">Bhutan <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cape \">Cape <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Verde \">Verde <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cambodia \">Cambodia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cameroon \">Cameroon <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Canada \">Canada <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Qatar \">Qatar <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Chad \">Chad <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Chile \">Chile <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"China \">China <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cyprus \">Cyprus <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Vatican City \">Vatican City <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Colombia \">Colombia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Comoros \">Comoros <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"North Korea \">North Korea <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Korea South \">Korea South <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ivory \">Ivory <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Coast \">Coast <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Costa \">Costa <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Rica \">Rica <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Croatia \">Croatia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Cuba \">Cuba <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Denmark \">Denmark <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Dominica \">Dominica <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ecuador \">Ecuador <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Egypt \">Egypt <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"El Salvador \">El Salvador <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"United Arab Emirates \">United Arab Emirates <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Eritrea \">Eritrea <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Slovakia \">Slovakia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Slovenia \">Slovenia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Spain \">Spain <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"United States \">United States <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Estonia \">Estonia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ethiopia \">Ethiopia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Philippines \">Philippines <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Finland \">Finland <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Fiji \">Fiji <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"France \">France <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Gabon \">Gabon <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Gambia \">Gambia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Georgia \">Georgia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ghana \">Ghana <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Grenada \">Grenada <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Greece \">Greece <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guatemala \">Guatemala <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guyana \">Guyana <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guinea \">Guinea <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Equatorial \">Equatorial <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guinea \">Guinea <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Guinea-Bissau \">Guinea-Bissau <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Haiti \">Haiti <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Honduras \">Honduras <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Hungary \">Hungary <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"India \">India <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Indonesia \">Indonesia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iraq \">Iraq <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iran \">Iran <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ireland \">Ireland <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Iceland Islands \">Iceland Islands <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Marshall Islands  \">Marshall Islands  <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Solomon \">Solomon <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Israel \">Israel <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Italy \">Italy <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Jamaica \">Jamaica <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Japan \">Japan <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Jordan \">Jordan <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kazakhstan \">Kazakhstan <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kenya \">Kenya <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kyrgyzstan \">Kyrgyzstan <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kiribati \">Kiribati <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Kuwait \">Kuwait <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Laos \">Laos <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Lesotho \">Lesotho <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Latvia \">Latvia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Lebanon \">Lebanon <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Liberia \">Liberia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Libya \">Libya <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Liechtenstein \">Liechtenstein <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Lithuania \">Lithuania <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Luxembourg \">Luxembourg <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"North Macedonia \">North Macedonia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Madagascar \">Madagascar <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Malaysia \">Malaysia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Malawi \">Malawi <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Maldives \">Maldives <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mali \">Mali <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Malta \">Malta <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Morocco \">Morocco <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mauritius \">Mauritius <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mauritania \">Mauritania <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mexico \">Mexico <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Micronesia \">Micronesia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Moldova \">Moldova <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Monaco \">Monaco <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mongolia  \">Mongolia  <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Montenegro \">Montenegro <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Mozambique \">Mozambique <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Namibia \">Namibia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nauru \">Nauru <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nepal \">Nepal <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nicaragua \">Nicaragua <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Niger \">Niger <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nigeria \">Nigeria <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Norway \">Norway <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"New Zealand \">New Zealand <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Oman \">Oman <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Netherlands \">Netherlands <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Pakistan \">Pakistan <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Palau \">Palau <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Panama \">Panama <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Papua New Guinea \">Papua New Guinea <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Paraguay \">Paraguay <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Peru \">Peru <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Poland \">Poland <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Portugal \">Portugal <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"United Kingdom \">United Kingdom <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Central African Republic \">Central African Republic <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Czech Republic \">Czech Republic <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Republic of the Congo \">Republic of the Congo <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Democratic \">Democratic <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Republic of the Congo \">Republic of the Congo <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Dominican \">Dominican <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Republic Rwanda \">Republic Rwanda <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Romania \">Romania <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Russia \">Russia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Samoa \">Samoa <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Kitts and Nevis \">Saint Kitts and Nevis <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Marino \">Saint Marino <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Vincent and the Grenadines \">Saint Vincent and the Grenadines <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Saint Lucia \">Saint Lucia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sao \">Sao <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tome and Principe \">Tome and Principe <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Senegal \">Senegal <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Serbia \">Serbia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Seychelles \">Seychelles <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sierra \">Sierra <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Leone  \">Leone  <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Singapore \">Singapore <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Syria \">Syria <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Somalia \">Somalia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sri Lanka \">Sri Lanka <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Swaziland \">Swaziland <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Africa \">South Africa <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sudan \">Sudan <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"South Sudan \">South Sudan <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Sweden \">Sweden <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Switzerland \">Switzerland <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Suriname \">Suriname <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Thailand \">Thailand <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tanzania \">Tanzania <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tajikistan \">Tajikistan <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"East Timor \">East Timor <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Togo \">Togo <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tonga \">Tonga <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Trinidad and Tobago \">Trinidad and Tobago <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tunisia \">Tunisia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Turkmenistan \">Turkmenistan <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Turkey \">Turkey <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Tuvalu  \">Tuvalu  <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ukraine \">Ukraine <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uganda \">Uganda <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uruguay \">Uruguay <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uzbekistan \">Uzbekistan <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Vanuatu \">Vanuatu <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Venezuela \">Venezuela <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Vietnam \">Vietnam <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Yemen Djibouti \">Yemen Djibouti <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Zambia \">Zambia <\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Zimbabwe\">Zimbabwe<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-message elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMedical \/ Surgical history\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[message]\" id=\"form-field-message\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-reportscopy elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-reportscopy\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tMedical reports copy (Total size of your report attachments should be less than 6MB. Allowed file types: JPG, PDF, DOCX.)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[reportscopy][]\" id=\"form-field-reportscopy\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" multiple=\"multiple\" data-maxsize=\"6\" data-maxsize-message=\"Diese Datei \u00fcbersteigt die maximale Dateigr\u00f6\u00dfe.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-privacypolicy elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-privacypolicy\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDeclaration and Data Privacy Consent Form:  <br>By signing this form, I declare that the information I have given is true, correct, and complete. I understand that failure to answer any question or giving a false answer can be penalized in accordance with the law.<br>  I also voluntarily and freely consent to the collection and sharing of the above personal information only in relation to COVID-19 business operation requirements and in accordance with the Data Privacy Act. For any concerns, you may contact info@kurresortlanka.com<br><br>I confirm that I have agree with the terms & conditions \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Yes\" id=\"form-field-privacypolicy-0\" name=\"form_fields[privacypolicy][]\"> <label for=\"form-field-privacypolicy-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"No\" id=\"form-field-privacypolicy-1\" name=\"form_fields[privacypolicy][]\"> <label for=\"form-field-privacypolicy-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha elementor-field-group elementor-column elementor-field-group-field_f151058 elementor-col-100\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_f151058\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6LcJyAQkAAAAAFSXnWdH3TAHAHDuM3hbng5aBEix\" data-type=\"v2_checkbox\" data-theme=\"light\" data-size=\"normal\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button type=\"submit\" class=\"elementor-button elementor-size-md\">\n\t\t\t\t\t\t<span >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\" elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fa333df elementor-widget-divider--view-line elementor-invisible elementor-widget elementor-widget-divider\" data-id=\"fa333df\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInUp&quot;}\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f0a7fcf elementor-invisible elementor-widget elementor-widget-text-editor\" data-id=\"f0a7fcf\" data-element_type=\"widget\" data-settings=\"{&quot;_animation&quot;:&quot;fadeInUp&quot;}\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p>2024 \u00a9 Copyright Kur Resort Lanka am See. All Rights Reserved<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Back to Home MEDICAL DECLARATION FORM 2024 \u00a9 Copyright Kur Resort Lanka am See. All Rights Reserved<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8889","page","type-page","status-publish","hentry","post-no-thumbnail"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/www.kurresortlanka.com\/de\/wp-json\/wp\/v2\/pages\/8889","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.kurresortlanka.com\/de\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.kurresortlanka.com\/de\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.kurresortlanka.com\/de\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.kurresortlanka.com\/de\/wp-json\/wp\/v2\/comments?post=8889"}],"version-history":[{"count":139,"href":"https:\/\/www.kurresortlanka.com\/de\/wp-json\/wp\/v2\/pages\/8889\/revisions"}],"predecessor-version":[{"id":10768,"href":"https:\/\/www.kurresortlanka.com\/de\/wp-json\/wp\/v2\/pages\/8889\/revisions\/10768"}],"wp:attachment":[{"href":"https:\/\/www.kurresortlanka.com\/de\/wp-json\/wp\/v2\/media?parent=8889"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}