Day 2 or Day 2 and 8 PCR Test Booking form

Day 2 or Day 2 and 8 PCR Test Booking formGlobal Health Travel Clinic2021-12-03T08:56:47+00:00

Please complete the following form for each member of your group.

This information is required in advance of testing.

Once we receive your request we will supply you with a:

secure payment link to pay in advance
a test booking reference/passenger locator code, supplied by Global Health Travel Clinic.

First Name *

Surname *

Sex *

Male

Female

Other / Not specified

Date of birth *

NHS Number (optional or not applicable)

Ethnicity *

Asian or Asian British

Black, African, Black British or Caribbean

Mixed or multiple ethnic groups

White

Another ethnic group

Prefer not to say

Your address whilst in the UK

Address line 1 *

Address line 2

Town or City *

Postcode *

Telephone number

Email address *

Have you received a vaccine against SARS-CoV-2 *

Yes

No

Coach number, flight number or vessel name (as appropriate) *

Passport number

The date on which you last departed from or transited through a country or territory outside the common travel area *

The country or territory travelling from when you arrived in the UK, and any country or territory you transited through as part of that journey *

Date of arrival in the UK *

Please ensure you have completed all the required fields before clicking submit. If you are part of a family or group you will need to submit a separate form for each individual.

Thank you for submitting your form.
If you are part of a family or group and wish to submit another form please click on the following link.

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