Form

First Name*

Last Name **

NHS number*

Home Address*

Including Post Code

The address provided to the test provider as the place where the international arrival is able to receive a confirmatory test*

Including Post Code

Phone Number*

(only in the case of SARS-CoV-2 positive or indeterminate results)

Email*

(only in the case of SARS-CoV-2 positive or indeterminate results)

Passport number or travel document number*

Coach number, Flight number or vessel name

(as appropriate)

The country or territory they were travelling from when they arrived in the UK*

Any country or territory they transited through as part of that journey

Test booking reference*

Please upload a clear photo of the entire test casette encompassing our unique QR code on it after you have taken the test. Unclear photos will be rejected and a certificate will not be issued.*

Max. file size: 128 MB.

No need to upload a photo of your ID/ Passport.

Purpose of Test*

Any other details you would like included on form:

Only required if using test for Day 2 tests

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