US Travel Certificate Application
PCR Testing for International Travel - The Centers for Disease Control and Prevention requires airline passengers to show proof of a negative coronavirus test before boarding an international flight to the United States. American Clinic Tokyo will conduct PCR testing for asymptomatic individuals preparing to travel. We do not perform PCR testing for symptomatic individuals. Cost: 30000 yen plus tax. Includes consultation, laboratory fees, and certificate fees. A physician signed report will be issued electronically and in writing. A Hawai’i state PCR negative certificate will be issued for travelers to Hawai’i.
Email address *
Last Name *
First Name *
Date of Birth *
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Phone
Departure Date *
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Departure Time *
Time
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Airport of Departure *
Destination (Country, State, Airport) *
Flight Number
When would you like to visit our clinic? Please note that the test must be conducted 72 hours prior to departure (or arrival at some destinations). *
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Time of visit to our clinic for sample collection. Please refrain from eating or drinking 30 mins prior to sample collection.
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I have read all of the above and agree to proceed in making an appointment at the American Clinic Tokyo. *
Required
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