Registration form for passing PCR-test
Please, fill up this form for passing PCR-test in laboratories and representatives of laboratories will contact you as soon as possible. They will provide you with detailed information, prices and the instructions for passing test. Stay healthy ;)
Name and surname *
Date of birth *
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Age *
Gender *
Contact phone number *
Contact email *
Citizen of *
Documents *
Adress of living (Country, city) *
Did you visit countries of red zone for last 14 days/ do you live in red zone country? *
Have you had a contact with a laboratory confirmed Covid-19 patient? *
Do you arrive at *
Indicate your arrival date to Ukraine *
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Indicate your departure date from Ukraine *
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Do you want pass a test in *
Do you agree to processing of your personal data and their transferring only to medical centers? *
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