COVID-19 DRIVETHRU TEST REGISTRATION FORM
Service by appointment between 8.00-12.00 and 13.00-15.00. Package Price is 4,000 Bath. Results will be available in 6-8 hours (Depends on number of people using the service)
Do you have any of these symptoms (You can answer more than one) *
Required
In past 14 days before you have any of these symptoms, Have you (You can answer more than one) *
Required
If you had any of a risk above on, you will not eligible to get a Drive Thru Service test.
*Our Nakhon Christian Hospital staff will contact you once you have completed this form.
Guide to our COVID-19 Drive Thru Service
1. Scan QR CODE to make an appointment.

2. Complete the registration form

3. Choose date/time of service (Our staff will confirm the date/time with you again)

4. Make a payment of 4,000 Baht via QR CODE and send slip to LIINE ID @nchhos

5. Drive to our Drive Thru Service station on appointment date/time

6. Lower vehicle window for our staff to perform swab test without getting out of the vehicle.

7. Drive home and wait for test results which will be available in 6-8 hours (Depends on number of people using the service)
Part 1. Patient Informations
Title *
Fullname *
Passport No. *
Date of Birth *
MM
/
DD
/
YYYY
Age *
Address *
Telephone No. *
ID LINE
E-MAIL
Travelling with personal vehicle. Vehicle Make and Model / Colour / Licence No. *
Part 2. Appointment
Date of Service *
MM
/
DD
/
YYYY
Time of Service (8.00-12.00 and 13.00-15.00)
Time
:
Part 3. Payment Method *
QR CODE for Mobile Banking Payment
Captionless Image
Part 4. COVID-19 Results Report Channels *
Part 5. Medical Certificate *
I agree to the terms and conditions. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy