Passenger Details

Your medical assessment form

The form takes about 5 minutes to complete, and our current average turnaround time is about 6 hours.
I confirm that I am over the age of 16 *
Do you require a Proof of Recovery from Covid Certificate for yourself or a child/dependant? *

Myself A child (under 16) or dependant
Where are you travelling? *

United States of America Australia Any other country

TRAVELLING TO THE UNITED STATES

Our Proof of Recovery from Covid Certificates are designed to be suitable for entry to the USA.

At the time of writing, the USA's rules state that the date of your first positive Covid-19 test must be between 6 and 90 days prior to your entry to the USA (11 days if you had severe Covid-19). Accepted tests include both both PCR tests and Rapid Antigen (aka Lateral Flow) tests. However, please note that these rules are subject to change at any time.

Please note that it is your responsibility to check that the contents of our certificate meet the latest requirements of the USA at the time of travel.
TRAVELLING TO THE EUROPEAN UNION

Our Proof of Recovery from Covid Certificates are designed to be suitable for entry to European Union countries.

The EU's rules state that the date of your first positive Covid-19 PCR test must be between 11 and 180 days prior to your entry to the EU. Please note that the rules of specific countries within the EU may differ and are subject to change at any time.

Please note that it is your responsibility to check that the contents of our certificate meet the latest requirements of your destination country at the time of travel.
TRAVELLING TO AUSTRALIA

Our Proof of Recovery from Covid Certificates are designed to be suitable for entry to Australia.

At the time of writing, the Australian Government's rules state that the date of your first positive Covid-19 PCR or lateral flow test (or rapid antigen) test must be at least 7 full days ago prior to your entry to Australia. You must also be free of Covid-19 symptoms for at least 72 hours. These rules are subject to change at any time.

Please note that it is your responsibility to check that the contents of our certificate meet the latest requirements of Australia at the time of travel.
TRAVELLING TO ALL OTHER COUNTRIES

Our Proof of Recovery from Covid Certificates are designed to be suitable for entry to most countries. Accepted tests include both PCR tests and Rapid Antigen (aka Lateral Flow) tests, however please check which type of test is required by your destination country.

Please note that it is your responsibility to check that the contents of our certificate meet the latest requirements of your destination country at the time of travel.

Details of Person Completing Form

Please enter the details of the person completing this application form
Name of person completing this form *

First Name Last Name
Please enter your relationship to the person travelling *

Passenger Details

Please enter the details of the person that requires the Proof of Recovery from Certificate
Passenger Name *

First Name Last Name
Passenger Gender *

Female Male Other
Passenger Date or Birth *

Day Month Year
Contact Email (Covid Recovery Certificate will be sent to this email address) *

Confirmation Email example@example.com
Contact Phone Number *

Country Code Phone Number
Passenger Address *

Street Address

Street Address Line 2

City County / State

Postal / Zip Code
Passenger Passport/ID Number *
Please upload a clear image of the passenger's passport photo page (or ID card) *

Accepted file types: pdf, jpg, jpeg, png
Cancel of

Please enter the date of the passenger's first positive PCR test for Covid-19 (this is the date on which the swab sample was taken) *

Day Month Year
The date of your PCR test must be at least 5 full days before today, but no more that 90 days before today.
Please enter the date of the passenger's first positive test for Covid-19 (this is the date on which the swab sample was taken) *

Day Month Year
The date of your Covid test must be at least 10 full days before today, but no more that 90 days before today.
Please enter the date of the passenger's first positive test for Covid-19 (this is the date on which the swab sample was taken) *

Day Month Year
The date of your Covid test must be at least 7 full days before today, but no more that 180 days before today.
Please enter the date of the passenger's first positive Covid-19 test (this is the date on which the swab sample was taken) *

Day Month Year
The date of your Covid test must be at least 7 full days before today, but no more than 90 days before today.
Which type of Covid-19 test have you taken? *

PCR Test Lateral Flow / Rapid Antigen Test
In which country did you take your Covid-19 Test?
Please check whether Lateral Flow / Rapid Antigen tests are allowed by your destination country, as evidence of Covid infection/recovery.
Lateral flow (aka rapid antigen) tests must be undertaken by or under the supervision of a medical practitioner (e.g. pharmacist, general practitioner, nurse, pathology collector or trained personnel at a testing station).
I confirm that I have fully completed self-isolation as per the current regulations of the UK Government. *

I confirm
CLICK HERE to see the UK Government's latest regulations for self-isolation.
The rules of individual countries within the EU may vary. Therefore please check the specific rules of your destination country to ensure that the date of your Covid test is within the appropriate timeframe.
Please upload the report of the passenger's positive Covid-19 test. See below for further details *

Accepted file types: pdf, jpg, jpeg, png
Cancel of
I confirm that the evidence of my positive Covid test has not been amended or falsified in any way. *

I confirm
If you are submitting an NHS test result, this may be a PDF copy of your NHS email notification or a copy of the official laboratory report (CLICK HERE find out how to access the report).

The following information must be clearly visible in English on your Covid-19 test report:
- PASSENGER FULL NAME
- PASSENGER DATE OF BIRTH
- TYPE OF TEST (PCR or Lateral Flow)
- DATE THE SAMPLE WAS TAKEN
- POSITIVE RESULT
- NAME OF LABORATORY (not required for NHS tests)

Has the passenger been advised by a doctor to avoid travelling due to medical reasons? *

YES NO
Has the passenger been advised by a doctor to shield at home because they are medically vulnerable? *

YES NO
Unfortunately we cannot issue a certificate at present as the medical information provided does not fulfil the necessary criteria.

Conditions of our Covid Recovery Certificate Service

Please carefully review our T&Cs and answer the questions below.
I have checked that the contents of Aasha Testing's Proof of Recovery from Covid Certificate (provided by The Montague Clinic - see below) fulfils the criteria of my destination country. *

I agree
I agree that I have fully understood the questions in this application form and have answered each question honestly & truthfully. *

I agree
I agree that I must undergo another medical assessment if I develop any new symptoms of Covid-19. *

I agree
Serial Number *
Date of Assessment

Day Month Year
Calculation
Days since test USA mild
Days since test USA severe
Days since test general
Days since test Australia
Days since Covid Test

Payment

My Products *

Covid Recovery Certificate Approved by Doctors at The Montague Clinic

£ 65.00 Quantity

Enter coupon

Total

£ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

If you require a copy of your payment receipt sent to an alternative email, then please enter it here (optional):
Please enter a valid email address
Should be Empty:

Your medical assessment form

Details of Person Completing Form

Passenger Details

Medical Questions

Conditions of our Covid Recovery Certificate Service

Payment