Departures PCR / Rapid Lateral Flow Test Booking Form

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At The Melton Clinic we provide fast, reliable and accurate Covid Testing.

We are a government listed and UKAS private provider of coronavirus testing. With in-clinic, postal and home visiting testing options available we have got all your needs covered.

Step 1: Please complete this form
Step 2: We will call you once we have received your form to book an appointment and make payment

To check your travel requirements please visit https://www.gov.uk/foreign-travel-advice

Email *

Which Covid-19 testing service do you require? *

PCR Same Day Results: £149: Available Mon - Sat Mornings, Guaranteed results same day by 10.30pm

PCR Next Day Results: £79: Available daily except Saturday, Guaranteed results next day by 8.30pm

Rapid Lateral Flow Test (Rapid Antigen): £39: Available daily, Guaranteed results in 30 minutes

By booking in you accept that you agree to the Terms and Conditions for Covid Testing (https://www.themeltonclinic.co.uk/terms-and-conditions-for-covid-testing) *

I agree

Title *

Mrs

Master

Other:

Full Name (as appears in Passport / Travel Document) *

Sex *

Male

Female

Date of Birth (dd/mm/yyyy) *

Passport Number *

Ethnicity *

Home Address (including Postal / Zip Code) *

Mobile Number *

Landline Number

Email Address (E-mail that results/certificate will be sent to) *

Covid Vaccination Status (Name of Vaccine, Date of administration, Country of administration) *

Flight / Coach / Vessel Number *

Date of Travel (dd/mm/yyyy) *

Time of Travel *

Time

A copy of your responses will be emailed to the address you provided.

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