FORM
COVID-19 TEST REQUEST

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Click HERE if you have already filled out this form before!


Name and last name (passport)
Passport number

Birthdate
Month: Day: Year:


Age
Address in Costa Rica
Reason for the test
Nacionality

Tutor: name and ID or passport
(Applies only to minors under 18 years old)

Phone number
E-mail address
 
Secundary E-mail (Optional)
 
Language of the result
PDF file in?




Select the type of test you need
PCR or Antigen?




Flight Information
¡Important to know when is the right time to test!
Departure date:
<December 2021>
SunMonTueWedThuFriSat
1234
567891011
12131415161718
19202122232425
262728293031

Please select the departure date


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Hoy miércoles 8 de diciembre abierto de 7:00 am - 1:00 pm
[  Horario de atención  ]


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