Kindly fill out the following to book for a test
Choose your Prefered Package
Siver - (120 GHC) - HIV | Hepatitis B | Hepatitis C | Syphilis
Gold (215 GHC)- HIV | Hepatitis B | Hepatitis C | Syphilis | Chlamydia | Gonorrhoea | Urinary Tract Infection (males) | Candidiasis (females) | Bacterial Vaginosis (females)
Platinum (280)- HIV | Hepatitis B | Hepatitis C | Syphilis | Chlamydia | Gonorrhoea | Urinary Tract Infection (males) | Candidiasis (females) | Bacterial Vaginosis (females) | Blood Group | Blood Genotype (sickle cell status)
Couples' Package (GHC250 for 2) - HIV | Hepatitis B | Syphilis | Blood Group | Blood Genotype (Sickle Cell Status)
I want some specific tests only. (Choose from below)
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.
HIV (GHC 40) - INSTANT
HEPATITIS B (GHC 40) - INSTANT
HEPATITIS C (GHC 50) - INSTANT
SYPHILIS (GHC 60) - INSTANT
Herpes I & II (GHC 280)
FOR MALES - GONORRHOEA / CHLAMYDIA / URINARY TRACT INFECTION (GHC 110) 3-5 DAYS
FOR FEMALES - GONORRHOEA / CHLAMYDIA / CANDIDIASIS / BACTERIAL VAGINOSIS (GHC 110) - 3-5 DAYS
FOR FEMALES - URINARY TRACT INFECTIONS (GHC 60)
FOR FEMALES - PAP SMEAR (GHC 280) - 2 WEEKS
FOR FEMALES - PREGNANCY TEST (GHC 40) - SAME DAY
BLOOD GROUP (GHC 40) - SAME DAY
BLOOD GENOTYPE (SICKLE CELL STATUS) (GHC 60) - SAME DAY
None of the above
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?
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?
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service