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Covid pre flight testing (PCR testing)- NHL- Data collection form
Please fill out all fields completely to prevent any delays in processing your purchase. Please fill out a new form for each test to be purchased. By completing this for I the undersigned acknowledge A Mann LTD T/A NHL Pharmacy is not held liable or responsible (inc financial) for any inaccuracy or delays experienced in obtaining results. I the customer must contact NHL to correct any inaccuracies or non receipt of certificated after the sample is taken.
By completing this form you consent for your data to be shared with the pharmacy and NHS

Disclaimer-
NHL pharmacy & Eyecare take no liability for losses financial or otherwise in connection with test results or difficulties boarding your flight. We aim to provide results within 48 hours of swabs taken but cannot guarantee this due to factors out of our control. The traveler assumes complete and full responsibility for all aspects of the passengers travel arrangements. By completing this form, you agree that all information provided is correct. We may also ask you fill out a paper copy of this form in store which must be signed and dated.

WE DO NOT take responsibility for any incorrect or unclear information. IT IS YOUR responsibility to check all information is correct on the certificate provided and any queries must be emailed to esales@nhlpharmacy.co.uk and call 01772700483

If your results have not arrived by the time agreed then it is your responsibility to contact NHL pharmacy at the above email address
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Date of Test *
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DD
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First name *
Surname *
Date of Birth *
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DD
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YYYY
Sex *
Home Address *
Post Code *
Email Address *
Phone Number *
Ethnicity *
Passport Number *
Date of Departure *
MM
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DD
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YYYY
Name of country travelling to *
Please declare your vaccination status *
Vaccination Status *
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