JACE Medical Covid Testing

COVID Test
What covid test do you require?*

PCRRapid PCRRapid Antigen (Lateral Flow)Antibody
Is your test to facilitate travel*

YesNo
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Your Details

Please ensure your details are correct
Do not delete this field.
Name*

First NameSurname
Gender*
Date Of Birth*

DayMonthYear
Email*
example@example.com
Phone Number*
Passport Number *
Ethnicity
Address*

Street Address

County

CityCounty

Postal / Zip CodeCountry

Appointment Time

Please select the time of test
Please select appointment time required*
If you require an appointment outside this time, please contact us and we will do our best to accommodate.

Appointment Location

Please select the location of test
Do you require a mobile appointment (This will require a supplemental charge)*

YesNo
Your test will be perfromed at JACE Medical, The Vale Centre, Greysteel, BT47 3GE
Your test will be performed at:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address preference
Location of Test

Outcome - Antibody
Test ID*
Time of Sample*

DayMonthYear

Minutes
Time of test*

DayMonthYear

Minutes
Please mark outcome*

Presence of IgGPresence of IgMNone
var1
var2
detected/not detected

Outcome - Antigen
Test ID*
Time of Sample

DayMonthYear
Date
Minutes
Time of test

DayMonthYear
Date
Minutes
Please mark outcome*

PositiveNegative
Detected/not detected (antigen)

Outcome - Rapid PCR
Test ID*
Time of Sample*

DayMonthYear

Minutes
Time of test*

DayMonthYear

Minutes
Please mark outcome*

PositiveNegative
Please enter the CT Value
Detected/not detected (PCR)

Outcome - PCR
Test ID*
Time of Sample*

DayMonthYear

Minutes
Time of test*

DayMonthYear

Minutes

Checkout
Your test ordered

PCR£69.00Rapid Antigen£9.99Rapid PCR£120.00Rapid Antibody£9.99Mobile Call Out Supplement£30.00
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Total Amount
Your test ordered

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