Create - PCR Scheduler

Items marked

are Required Fields.

Please be informed that processing of results takes between 24-48hrs from the date of testing
Do ensure that all information entered on this form is correct prior to sending
Please check with the country to which you are travelling to confirm the maximum time for which your PCR test will be valid, when selecting a test date.
Do not attempt to book on the same day you will need the to take the test.
You may pay for your test online at: E-Payment and walk with a Printed Copy of the receipt. You may also opt to pay for the appointment at the Dominica-China Friendship Hospital.
Please ensure you are on time for you appointment, late arrival does not ensure that your results will be ready on time as processing takes 24-48hrs.
For any queries or comments, please contact us at Tel: 7676113905 or 7676183905

Appointment Date:

Appointment Time:

I agree to receive results via Email.

Testing Site

Last Name

First Name

Middle Name

Date of Birth

Gender

Street

Address of Accommodation

Village/Town

Nationality

Phone

Email Address

Re-enter Email

ID Type

ID Number

Next of Kin - First Name

Next of Kin - Middle Name

Next of Kin - Last Name

Address (Next of Kin)

Phone (Next of Kin)

Email (Next of Kin)

Vaccination Status

Vaccine Type

First Dose Date

VaccFinalDoseDate

Asthma

Diabetes

Hypertension

Cancer

AutoImmuneDisease

ChronicBronchitis

OtherConditions

Other Conditions

Date of Travel

Place of Employment

Last day at work

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