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PATIENT INFORMATION FORM

UK Arrival Day 2 (£59)
PCR Test
Appointment

Location:

Gender:

First Name (including middle names):

Surname:

Date of Birth:

Passport number:

Email: Copy same data to next entry

Confirm Email:

Mobile:

Address: I will isolate at this address

Isolation address:

City:

Postcode:

UK Arrival Date:

-2023

UK Arrival Time (24 hours Format):

Coach, flight or vessel number:

Coming from countries:

Departure date:

-2023

Day 2 Test Date:

-2023

Any COVID-19 symptoms?

Are you UK approved fully vaccinated?

Ethnicity

SARS-CoV-2 PCR

SARS-CoV-2 PCR (same day) SARS-CoV-2 PCR (24 hours)

SARS-CoV-2 Ab / Ag

SARS-CoV-2 Antibodies SARS-CoV-2 Spike Antibodies SARS-CoV-2 Rapid Antigen SARS-CoV-2 Antigen

Booking/order reference number (if applicable)

MEDIS

SPECIMEN INFORMATION

Throat/Nasal Swab or Nasopharyngeal Swab

Throat Swab

Nasal Swab

Serum

REASON FOR TESTING

Work

Diagnosis

Travel (Fit to Flight)

Contact of confirmed case

D/Passport expiry date (if applicable):

Have you travelled internationally in the last 14 days?
Yes No

Country and return date:

SARS-CoV-2 PCR

Day 2 and Day 8 Testing for Internation Arrival

SARS-CoV-2 PCR (Day 2)

SARS-CoV-2 PCR (Day 8)

Test to Release (Day 5)

SARS-CoV-2 PCR (same day)

SARS-CoV-2 PCR (24 hours)

Booking/order reference number (if applicable)

MEDIS

SPECIMEN INFORMATION

Throat/Nasal Swab or Nasopharyngeal Swab

Throat Swab

Nasal Swab

Serum

TRAVEL HISTORY

ID/passport number:

Verify Your Details

Name
Email
Date of Birth
Appointment Date Appointment Time
Mobile
Address
City
Postcode

Book Now !

Fit to Fly Certificate
UK Arrival Day 2 (£59) Appointment

Name

Appointment Date Appointment Time

Please bring your Original Passport with you.

Insta Care Solutions Collection Point

79 Tooting High Street,
Tooting Broadway, London.
SW17 0SU

07778882464

Very nice service.

Rao Khan

Great service

Atiqul hassan Malik

your service is amazing!!!! on time with the good guidance.... Great customer service...

Vadivelu Kamalenthiran

Such a great service. So fast & great customer service. Smooth, fast & stress free. Would definitely use this service again!

Nicole jayne Cotter

Responsive and efficient. The test was quick and the results arrived as promised. Recommended!

Michael Schaffer

Highly recommended

Waqar Hassan

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