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Portugália Tasca

Amount of people *

Date *

Time *

Name *

Phone number *

Email *

Does your reservation consist of one household? *
Yes No

Have you had any of the following complaints in the past 24 hours? Cold, cough, fever and / or shortness of breath. *
Yes No

Do you have a housemate with a fever or shortness of breath? *
Yes No

Have you had the new corona virus and has this been diagnosed in a lab in the past 7 days? *
Yes No

In the past 14 days, have you been in contact with someone who has corona? *
Yes No

Bent u nu in quarantaine vanwege direct contact? *
Yes No

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Bakkersstraat 12
1017 CW, Amsterdam

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