COVID-19 Test Registration Form
(Only for International travellers)
Fields marked * are mandatory!
Travel Destination
*
Select
Afghanistan
Albania
Algeria
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Belarus
Belgium
Belize
Bolivarian Republic of Venezuela
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Cambodia
Canada
Caribbean
Chile
China
Colombia
Costa Rica
Croatia
Czech Republic
Denmark
Dominican Republic
Ecuador
Egypt
El Salvador
Eritrea
Estonia
Ethiopia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Greenland
Guatemala
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Korea
Kuwait
Kyrgyzstan
Lao PDR
Latvia
Lebanon
Libya
Liechtenstein
Lithuania
Luxembourg
Macao SAR
Macedonia (Former Yugoslav Republic of Macedonia)
Malaysia
Maldives
Malta
Mexico
Mongolia
Montenegro
Morocco
Nepal
Netherlands
New Zealand
Nicaragua
Nigeria
Norway
Oman
Pakistan
Panama
Paraguay
Peru
Philippines
Poland
Portugal
Principality of Monaco
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro (Former)
Singapore
Slovakia
Slovenia
South Africa
Spain
Sri Lanka
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Thailand
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
U.A.E.
Ukraine
United Kingdom
United States
Uruguay
Uzbekistan
Vietnam
Yemen
Zimbabwe
Date of Travel
*
Test type
*
RTPCR(Rs- 500)
Express Testing(Rs- 3000)
Test Date
*
Reason for testing
*
Complete Name
*
Age(Years)
*
Gender
*
Male
Female
Other
Contact Number
*
Email ID
*
Hospital Number(Patient Registration Card of KH)
Father's Name
*
Address
*
Passport Number
*
Present symptoms
Date onset of first symptoms
Pre existing medical condition
*
Received COVID-19 vaccine
*
Yes
No
If Yes, Vaccine Name
Date of Dose 1
Date of Dose 2
Aadhar Number
Have you downloaded Aarogya Setu app
*
Yes
No
Have you come in contact with any lab confirmed COVID-19 patient
*
Yes
No
If Yes, Date of exposure
*
Name of the person
*
Any history of travel in last one month
*
Yes
No
If Yes,place and date
*
History of COVID-19 test previously
Date:
Test report
After successful payment please download the receipt and produce it during the sample collection.