The information you provide on this form should contain the exact same personal data as on your current valid identification document. It is also very important to accurately describe the symptoms based on your health status.We recommend you meticulously check the personal data you’ve entered, such as: full name, date of birth, and identification document numberThe results will be reported with the information you provide and the clinical laboratory will not be responsible for changing data that differs from the data provided on this form.Your contact information, such as exact address, telephone number, and email address, are also essential so that the clinical laboratory and the Costa Rican Ministry of Health authorities can locate you if necessary, since as part of the COVID-19 (SARS-CoV2) epidemiological control the laboratory is required to notify the Ministry of Health of the results.
* Indicates required field
Patient is a minor?
For minors (*) or patients with a legal tutor:
This test is for travel reasons?
Work in Costa Rica?
Have you had symptoms of covid or in contact with a case?