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

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:
<August 2021>
SunMonTueWedThuFriSat
1234567
891011121314
15161718192021
22232425262728
293031
Please select the departure date


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