Registration form Please complete the below form and our COVID-19 response team will call you back to book your appointment time. Covid-19 Screening Appointment Registration Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Title Given Names Surname Contact Number(Required)Reason for having a COVID-19 test(Required)Choose from the drop down listHaving symptoms of coronavirus (COVID-19)Close contact of a person who has tested positive for COVID19Been to a exposure site - Tier 1Been to a exposure site - Tier 2Returned traveller (international or interstate)To have a surgery or a planned hospital stayWork PurposeTravel PurposeOtherPlease enter the reason for testing(Required) For whom are you completing this registration?(Required)Choose from the drop down listJust me (16 years and above)Myself and my dependentsJust my dependentsPlease enter the number of dependents accompanying for COVID testing and their age(Required) When do you require a test appointment(Required)Choose from the drop down listNext available clinicSpecific dateDate by which appointment is needed(Required) DD slash MM slash YYYY EmailThis field is for validation purposes and should be left unchanged.
