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:
<June 2024>
SunMonTueWedThuFriSat
1
2345678
9101112131415
16171819202122
23242526272829
30

Please select the departure date


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