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 COVID-19Returned international travellerTo 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 dependantsJust my dependantsPlease enter the number of dependants 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 NameThis field is for validation purposes and should be left unchanged.
