Covid Test Los Cabos

Covid Test Questionnaire

Please fill in all the required fields in order to submit your form. Make sure all the names and information MATCH the passport, this will be checked by the airlines.
Full Name EXACTLY as in passport*

Name and middle nameLastname
Date of Birth*

MonthDayYear
Age*
Email for results delivery*
Please double check your email adress
Phone Number
Please enter a valid phone number.
Gender*

MaleFemale
Passport Number*
Are you pregnant?

YesNo
Pregnancy time
Reason for getting tested*
Where are you traveling?*
US requires Antigen test, CAN requires Pcr test
Home Address

Street Address

Street Address Line 2

CityState

Zip Code
ZIP code*
your home ZIP code
Do you have US insurance?*

YESNO
US insurance name
Flight Date

MonthDayYear
Flight date

MesDíaAño
How many people are traveling with you?*
You can add up to 4 more people

Guest 1
Guest 1 Info
Full Name EXACTLY as in passport*

Name and middle nameLastname
Date of Birth*

MonthDayYear
Age*
Gender*

MaleFemale
Passport Number*
Do you have US insurance?*

YESNO
US insurance name
Is she pregnant?

YesNo
Pregnancy time

Guest 2
Guest 2 info
Full Name EXACTLY as in passport*

Name and middle nameLastname
Date of Birth*

MonthDayYear
Age*
Gender*

MaleFemale
Passport Number*
Do you have US insurance?*

YESNO
US insurance name
Is she pregnant?

YesNo
Pregnancy time

Guest 3
Guest 3 info
Full Name EXACTLY as in passport*

Name and middle nameLastname
Date of Birth*

MonthDayYear
Age*
Gender*

MaleFemale
Passport Number*
Do you have US insurance?*

YESNO
US insurance name
Is she pregnant?

YesNo
Pregnancy time

Guest 4
Guest 4 info
Full Name EXACTLY as in passport*

Name and middle nameLastname
Date of Birth*

MonthDayYear
Age*
Gender*

MaleFemale
Passport Number*
Do you have US insurance?*

YESNO
US insurance name
Is she pregnant?

YesNo
Pregnancy time

Section stopper
When did you start with your symptoms?

MonthDayYear
Date

Where are you staying?*
San José del CaboCabo San Lucas
What is the address?*

Street Address

Name or number of the house

House developmentState / Province

Reference to arrive
Hotel or Resort name
Please make sure the resort will allow testing from us.
Room number
Test needed for your destination:*

ANTIGEN Covid-19 testPCR Covid-19 test
PCR Test Appointments*
Antigen Test Appointments*
Date

MonthDayYear
Date
Should be Empty: