COVID fit to fly & Antigen booking form

COVID fit to fly & Antigen booking form
Which test(s) would you like?*

RT-PCR TestAntigen Lateral Flow test
Please note you are responsible for checking you have picked the correct test for the country your are visiting for travel purposes
Todays date:*

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

First NameMiddle NameLast Name
Sex*

MaleFemaleN/A
Date of Birth*

DayMonthYear
Passport/ID card number :*
Please enter your residential address or if you are visiting the address you are staying at.*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please enter the address you would like on your certificate (if you live abroad) and it is different to the above.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number Mobile :
Phone Number Home :
Email*
example@example.com
Country of travel*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of flight/travel :*

DayMonthYear
Date
Time of flight/travel*

Hour Minutes

AM/PM Option
How many hours before travel does the test need to be taken ?*
Before arrivalBefore departure
Additional information:
In an event of an emergency please contact:
Name*

First NameLast Name
Telephone :
Relationship to you:*
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: