COVID-19 Day 2 PCR Test

COVID-19 Day 2 PCR Test

40 Knightsbridge, London, SW1X 7JN
- Patient Name*
  
  First NameLast Name
- Date of Birth*
  
  DayMonthYear
- Gender*
  
  MaleFemale
- Country of Residence*
- Ethnicity*
- Passport Number*
- Are you Vaccinated
- Address (Where you will stay in the UK)*
  
  Street Address
  
  Street Address Line 2
  
  CityTown / County / Province / State
  
  Post CodeCountry
- Contact Number*
- Email*
- Date & Time of Your Arrival In The UK*
  
  DayMonthYear
- Country You Are Arriving From*
- Flight / Train / Vessel Number*
- Flight Day*
  
  DayMonthYear
- Do you Require Tests for your Departure Flights From the UK?*
  
  YesNo
- Select Type of COVID-19 Test*
  
  Fit-to-Fly PCR TestFit-to-Fly 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)
- 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?
- - Internal Use -
  
  Test Appointments & Certificates
- FTF Provider
  
  TDLRandox360
- D2/D8 Test Provider
  
  Randox360
- Fit-to-Fly Test Appointment Slot
  
  DayMonthYear
  Date
  Hour Minutes
- Test Time & Date
  
  DayMonthYear
  Date
  Hour Minutes
- Report Issued
  
  DayMonthYear
  Date
  Hour Minutes
- SARS CoV-2 Result
  
  NEGATIVEPOSTIVE
- Detection of SARS CoV-2
  
  NOT DETECTEDDETECTED
- STATED SYMPTOMS ASSOCIATED WITH COVID-19
  
  NONE REPORTEDOther
- Fit-to-Fly
  
  YesNo
- D2/D8 Provider Cal
- FTF Provider Cal
- qrcal
- Package Calculation
- Email Add. Tests
- Certificate Number
- Unique Reference Number
  Booking Reference Number
- FTF Cert.
  
  Cancelof
- Day 2 Cert.
  
  Cancelof
- Option 1Option 2Option 3
- Option 1Option 2Option 3
- Option 1Option 2Option 3
- Option 1Option 2Option 3
- Option 1Option 2Option 3
- Option 1Option 2Option 3
- Option 1Option 2Option 3
- Option 1Option 2Option 3
- Option 1Option 2Option 3
- Should be Empty:

COVID-19 Day 2 PCR Test

Consent

- Internal Use -