COVID-19 PCR Lab test contact information
Booking form for COVID-19 PCR (with Fit to fly certificate) at Yakub Chemist.


Please enter the e-mail that can be used to send the results/certificate.

A copy of this form will also be sent to this email once submitted, sometimes this may appear in the junk/spam folder. If you have not received your confirmation AFTER submission, please contact us and we can provide a PDF of the form you have submitted.
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Email *
Please complete this form before you attend your appointment. Booking is not guaranteed until you have called to book an appointment and submitted this form.
IMPORTANT: Please ensure ALL details are correct because these details will be used to generate your results/certificate.

Please do NOT attend your appointment if you have any symptoms.
Check your symptoms first: https://111.nhs.uk/covid-19.

Disclaimer:
- Yakub Chemist are not responsible for any charges incurred in the unlikely event that you do not receive your results before your flight. Results may be negative, positive, or unclear.
- The test is non-refundable once sample is taken, irrespective of the results or circumstances. All results are automatically reported to UK Health Security Agency (UKHSA) (formerly Public Health England (PHE))
- If you test POSITIVE for COVID-19 then UKHSA/NHS Track and Trace will automatically be notified. If you test POSITIVE you MUST self-isolate and follow the Government guidelines.
Please follow the Government guidelines and national lockdown travel rules
For the latest guidance visit: https://www.gov.uk/coronavirus
Get advice about travelling abroad, including the latest information on coronavirus, safety and security, entry requirements and travel warnings.
Which COVID-19 PCR testing service do you require? *
Please speak to the pharmacist for more information. IMPORTANT: WE WILL NEVER ASK YOU TO PAY ONLINE OR BEFOREHAND FOR PCR FIT TO FLY TESTS. ALL PAYMENTS WILL BE TAKEN IN-PERSON AT TIME OF APPOINTMENT. No booking fee. No cancellation fee. It is the patient's responsibility to ensure they have been booked for the correct type of test.
Full name [FORMAT: Forename, middle name, surname] *
Provide full name as per passport (include middle names if applicable)
NHS Number
Date of birth (DOB) *
Click the calendar icon to select DOB. IMPORTANT: YOU MUST ENSURE YOUR DOB IS IN THE CORRECT FORMAT. If the patient is under 18 years old, a parent/guardian will need to be present
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Address *
Please include first line of address, city, and postcode. Please provide the UK address where you are staying currently. The address does not appear on the certificate
Contact number *
Gender *
Passport number *
Please include if you would like this to appear on your certificate. Please bring your passport with your to verify the details. If you do not require the passport number to appear please put 'NA' for this question
Departure date and time *
Click the calendar icon to select date of departure. We recommend for you to book your ticket to ensure that your certificate is valid. If you do not have a departure time please put the time by which you require the certificate or your appointment time
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Time
:
Appointment/swab date and time *
This is the date you have booked your appoint at Yakub Chemist. Click the calendar icon to select date.
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/
DD
/
YYYY
Time
:
Where did you hear about us? *
Why do you require this service? *
I give consent to share my data with the Laboratory and UKHSA/NHS England for the specified processing purposes. If you test positive you may be contacted by NHS Test and Trace *
If you do not agree then we cannot proceed with the test
Required
A copy of your responses will be emailed to the address you provided.
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