FORM
COVID-19 TEST REQUEST

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Name and last name (passport)
Passport number

Birthdate
Month: Day: Year:



Age

Address in Costa Rica
Reason for the test
Nacionality
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 2022>
SunMonTueWedThuFriSat
123
45678910
11121314151617
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Please select the departure date


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