Day 2 PCR Test

Surname *

First name *

Date of Birth (dd/mm/yyyy) *

Gender *

Male

Female

Email *

Telephone *

Address (include Street and City ) *

Post Code

Arrival Date

Departure City

Have you been in a country or territory on the red list in the last 10 days ?

Departure Country

Type of Transport (Flight / Train/Vessel/Other)

Please insert Passport Number below

SARS-CoV-2 PCR *

Ethnicity: *

Vaccination Status (1st , both or None)

Best Sample Date (Date you will take the test)

Best Sample Time (Time you will take the test)

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