Kindly fill out the following to book for a test
Email address *
Choose your Prefered Package
Clear selection
If you chose the couple's package, what is the name of your partner whom you will be testing with?
Which other tests would you like to do? Only indicate tests that are not already in the selected package.
When would you like to have your test done? *
Choose your preferred time. (Available periods 8:30 am - 1:30pm and 2:30pm - 4:00pm) *
Would you prefer to have your test done in the convenience of your home or office or at a center? *
Full Name *
Age *
Phone Number *
If you selected Home Call, where would you like to have the test done? (Just give us an idea of the area. eg. Adenta SSNIT Flat)
Would you like to receive your results via E-mail? *
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