Book a test to release appointment 1. Date of Arrival MM slash DD slash YYYY (if you require a Test to Release: Day 5 for International Travelers)?2. Arrival Time (if you require a Test to Release for International Travelers)?Departure Date MM slash DD slash YYYY (if you require a Fit to Fly test)4. How many hours has your carrier specified for the Fit to Fly Test? 72 hours 48 hours 24 hours 12 hours 5. Forename 6. Surname 7. Gender Male Female Non Binary 8. Date of Birth MM slash DD slash YYYY 9. Passport/Document Number 10. Countries visited in the last 10 days (if any)? 11. NHS Number (if known) 12. Address (including postcode)13. Self Isolating Address including postcode (if different)14. Contact Telephone number 15. Email address 16. Ethnicity Bangladeshi Black Caribbean Black Other Chinese Indian Pakistani White White and Asian White and Caribbean White British White Irish White Other ISC - Unspecified Any other ethnic category Any other mixed/group Mixed/Other Unknown 17. Reasons for your test if a general test Contact/Exposure Return to work Symptoms Surveillance None of the above 18. Do you have any current symptoms for Covid-19? Cough Change/Loss of taste or smell Shortness of breath Sore throat Temperature Other flu-like symptoms No Untitled First Choice Second Choice Third Choice 19. Vaccination status None received First dose Two doses Prefer not to say 20. How would you like to pay? Bank Transfer Card payment
