COVID-19 PCR Test (Fit-to-Fly)
99 Edgware Road, London, W2 2HX
Patient Information
Patient 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 the location, date and time of your antigen 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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Certificate Fields
Select Service Provider
TDL
Randox
360
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
Service Provider Credentials
QRCAL
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