Global Express Travel Health Clinic Passenger Locator Form
As part of the Day 2 and 8 as well as Test to Release scheme, you are required to provide us with the following information.
This is a legal requirement.
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Email *
Name *
Date of Birth *
MM
/
DD
/
YYYY
Sex *
Required
Telephone number *
NHS Number
Passport number / ID card number
Ethnicity
Country of Departure *
Under the current UK government’s international travel ‘traffic light system’ (the green, amber and red list rules), will you be arriving from a green, amber or red list country? *
Date of Last Departure/Transit *
MM
/
DD
/
YYYY
Date of Arrival in the UK *
MM
/
DD
/
YYYY
Flight Number/Coach Number/Vessel Number/Train(Euro Tunnel)
Home Address including post code
Home Address to Isolate if Different
Vaccination Status *
Type of vaccine given - If Known
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