COVID day 2/8 & 5 Test to Release booking form

Covid Day 2 PCR Test

(for unvaccinated travellers)
Todays date:*

DayMonthYear
Please enter your name as it appears in your passport or ID card*

First NameMiddle NameLast Name
MissMrsMsMr
MaleFemaleN/A
Ethnicity:*
Date of Birth*

DayMonthYear
Passport/ID card number on passenger locator form : *
NHS number (if known and applicable):
Please enter your home address :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please enter the address you are self-isolating in the UK or would like a confirmatory PCR test sent (for day 2 antigen test only) if different to the above :

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Telephone number (home) :
Telephone number (mobile) :
Email*
example@example.com
Travel details:
County you are travelling from :*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
YesNo
If yes, please add which ones :
Date of last departure from or transit from non-exempt county :*

DayMonthYear
Date
Date of arrival in the UK :*

DayMonthYear
Date
Time of arrival in the UK :*

Hour Minutes

AM/PM Option
FlightTrainCoachBoatCar
Flight/ car/ train/ coach/ vessel number or name :*
COVID vaccination
YesNo
12
Name of the vaccine
Additional information:

Thank you for completing the booking form, please call us to book your appointment or if you have booked already we will see you then.
Please bring your passport or ID card that you are traveling with.
Should be Empty:

Covid Day 2 PCR Test