COVID-19 Test (Fit-to-Fly)
40 Knightsbridge, London, SW1X 7JN
Patient Information
Patient Name
*
First Name
Last Name
Date of Birth
*
-
Day
-
Month
Year
Gender
*
Male
Female
Passport Number
*
As shown on your passport
Contact Number
*
Please enter a valid phone number
Email
*
Certificate Number
Appointment
Please choose date and time of your PCR test.
Would You Like to Upgrade to the Express Service, to get your results in as little as 3 hours?
Yes (Results in 3 Hours)
No (Results in 24 hours)
Select Appointment Slot
*
Select Express Appointment Slot
*
Consent
By continuing with your booking you understand that you must not attend if you're presenting any COVID-19 symptoms including a temperature above 37.8°C, a persistent cough or have difficulties breathing. You may attend the centre once your symptoms have resolved and/or you have completed self-isolation for 10 days.
*
I, the above-mentioned patient, I hereby agree and confirm that the information provided in this request form is true and complete. I authorise Prince Pharmacy to forward the related information to governmental agencies if required to do so. I agree to self-isolate until my test is completed. If I test positive, I adhere to the current government guidelines relating to the COVID-19.
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Test Time & Date
-
Day
-
Month
Year
Date
Hour Minutes
Report Issued
-
Day
-
Month
Year
Date
Hour Minutes
SARS CoV-2
NEGATIVE
POSITIVE
STATED SYMPTOMS ASSOCIATED WITH COVID-19
NONE REPORTED
Other
Detection of SARS CoV-2 Antigen IVD
NOT DETECTED
DETECTED
Fit-to-Fly
Yes
No
Select Service Provider
TDL
Randox
360
Service Provider Credentials
QRCAL
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