COVID-19 Test-to-Release

Test-to-Release PCR Test

99 Edgware Road, London, W2 2HX
- Patient Name*
  
  First NameLast Name
- Date of Birth*
  
  DayMonthYear
- MaleFemale
- Country of Residence*
- Ethnicity*
- Passport Number*
- Are you Vaccinated
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityTown / County / Province / State
  
  Postal / Zip CodeCountry
- Contact Number*
  Please enter a valid phone number
- Email*
  example@example.com
- Date of Your Arrival In The UK*
  
  DayMonthYear
- Country You Are Arriving From*
- Flight / Train / Vessel Number*
- Date of Departure*
  
  DayMonthYear
- Yes (Results in 4 Hours)No (Results in 24 hours)
- When Choosing your Appointment, please select an appointment slot 5 days after your arrival into the UK.
  
  (You must complete 5 days of isolation, before doing your Test-to-Release Test)
- Select 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.Let's keep in touch! Would you like to receive information and promotions from Prince Pharmacy?
- File Upload
  
  Cancelof
- Should be Empty:

Test-to-Release PCR Test

Consent