appointmentform for Covid-19 test

Groupname if you are testing with multiple persons (This is just so the secretary can group your certificates together)

Preferred day for your appoinment. (If you have more or other preferences please state these in the message section below.)

Surname(s) (Exactly as in your Passport)

First Name(s) (Exactly as in your passport)

Passport or Travel Document number (exactly as on your Passport or Travel document)

Your Date of Birth.

Email Address

Telephone

Message

I authorize the processing of my data according to the Privacy Policy I authorize the use of my email for the sending and receiving of electronic communications.