ALL FIELDS ARE REQUIRED
Date of arrival into the UK:
Preferred time for video conference call / sample collection – if applicable: (*time cannot be guaranteed)
Patient Ref Number (Please see transaction receipt email if already ordered online):
Inbound Coach number / Flight number or Vessel name (as appropriate):
The date on which you last departed from or transited through a non-exempt country or territory, or a non-exempt region of a country or territory ‒ a destination not on the travel corridors list:
The country or territory you were travelling from when you arrived in the UK, and any country or territory you transited through as part of that journey:
Passport Number or ID card reference number:
COVID-19 Vaccination Status:
I hereby consent to a nose / throat swab test to detect or monitor the presence of Coronavirus COVID-19 via laboratory PCR testing. I accept that this test does not constitute a violation of my human rights. I understand and accept that Public Health England / the NHS may be notified regarding the outcome of the test and I will immediately follow the medical advice given at that point. I also give permission for the MHE Medical Advisory Board to access and review my test results and data. I understand records of the results of this test will be stored, processed and shared as necessary for Test To Release Scheme purposes or Day 2 and 8 Travel Testing and I agree to this. I also agree to receiving test results and electronic notifications by text and email. By signing below, I confirm I am in receipt of the GDPR Information below, explaining the data collected, how it is used, my rights in relation to it and the Data Protection Officer contact information (email@example.com).
Visit our Customer Reviews page to see what our customers say about us.