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:
<May 2022>
SunMonTueWedThuFriSat
1234567
891011121314
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22232425262728
293031

Please select the departure date


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Hoy viernes 27 de mayo abierto de 7:00 am a 1:00 pm / 2:00 pm a 4:00 pm
[  Horario de atención  ]


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