COVID-19 Travel Certification Form

COVID-19 Travel Certification Form
Please complete the enclosed form with your details and requirements

Once we have received your completed form our staff will contact you to arrange an appointment for a supervised RAT or PCR Test

Following this your travel certificate will be emailed to you
COVID-19 Test Type *

RAT PCR
Full Name (exactly per your Passport) *

First Name Middle Name Last Name
Birth Date *

Day Month Year
Gender
Medicare Card Number (if applicable)
Passport Number *
Destination
Airline
Departure Date & Time
Address *

Street Address

Street Address Line 2

City State

Postal Code Country
Phone Number *
E-mail *
example@example.com
*

I confirm that I have checked all the requirements and selected the correct COVID-19 test for my travel destination. (If you are not sure please check with the airlines and the embassy of your travel destination before booking a COVID-19 test/certification.)
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