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:
<August 2022>
SunMonTueWedThuFriSat
123456
78910111213
14151617181920
21222324252627
28293031

Please select the departure date


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Hoy viernes 12 de agosto abierto de 7:00 am a 1:00 pm / 2:00 pm a 4:00 pm
[  Horario de atención  ]


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