PCR Scheduler
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Instructions
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
Select Testing Site
Portsmouth Hospital
Newtown Health Center
Bio Data
Last Name
First Name
Middle Name
Date of Birth
Gender
Select Gender
Male
Female
Street
Address of Accommodation
Village/Town
Select Village/Town
ANSE DE MAI
ANSE SOL DAT
ANSE-A-LIANE
ANTRIM VALLEY
ATKINSON
BAGATELLE
BATACA
BATALIE
BATH ESTATE
BEAU BOIS
BELFAST
BELLE MANIER
BELLES
BELLEVUE CHOPIN
BELLEVUE RAWLE
BENSE
BIOCHE
BLENHEIM
BOETICA
BOURNE
CALIBISHIE
CAMPBELL
CANEFIELD
CAPUCHIN
CARHOLME
CASE O GOURIE
CASTLE BRUCE
CASTLE COMFORT
CHECKHALL
CITRONIER
CLARKE HALL
CLIFFTON
CLIFTON
COCKRANE
COLIHAUT
CONCORD
COPT HALL
CORONA ESTATE
COTTAGE
COULIBISTRIE
CRAYFISH RIVER
DELICES
DESPORT
DIXPAS
DOS D'ANE
DUBIQUE
DUBLANC
EGGLESTON
ELMSHALL
FOND BARON
FOND CANIE
FOND COLE
FOND MELLE
FOND ST. JEAN
FONDMELLE
FORTUNE
G/WILL
GALLION
GAULETTE
GIRAUDEL
GLANVILLIA
GOMIER
GOOD HOPE
GOODWILL
GRAND COULIBRI
GRAND FOND
GRANDBAY
GRANDE SAVANNE
GUTTER VILLAGE
HAMPSTEAD
HATTON GARDEN
HILLSBOROUGH
JIMMIT
KALINAGO TERRITORY
KINGSHILL
LA ROCHE
LAPLAINE
LAUDAT
LAYOU PARK
LAYOU VALLEY
LAYOU VILLAGE
LES POINTE
LONDONDERRY ESTATE
LOUBIERE
LOUISVILLE
MACOUCHERIE
MAHAUT
MARIGOT
MASSACRE
MAYO
MELVILLE HALL
MERO
MONTINE
MOORE PARK
MORNE BRUCE
MORNE DANIEL
MORNE JAUNE
MORNE PROSPER
MORNE RACHETTE
NEWTOWN
PAIX BOUCHE
PENRICE
PENVILLE
PETIT COLIBRI
PETITE SAVANNE
PETITE SOUFRIERE
PICARD
PICHELIN
POINT CARIB
POINTE GUINARD
POINTE MICHEL
POND CASSE
PORTSMOUTH
POTTERSVILLE
RAVINE COCQUE
REIGATE
REIGATE ESTATE
RIVER CLAIRE
RIVER ESTATE
RIVIERE CYRIQUE
RIVIERE LA CROIX
ROGER
ROSALIE
ROSEAU
SALISBURY
SALYBIA
SAN SAUVEUR
SAVANNE PAILLE
SAVANNE PARK
SCOTTS HEAD
SHAWFORD ESTATE
SILVER LAKE
SINEKU
SOUFRIERE
SPRINGFIELD
SPRINGHILL ESTATE
ST. AROMENT
ST. JOSEPH
STOCKFARM
STOWE
SULTAN
SYLVANIA
TAN TAN
TARISH PIT
TARREAU
TERRE FEMME
TETE MORNE
THIBAUD
TOUCARIE
TRAFALGAR
TRANTO
UNKNOWN
VICTORIA
VIEILLE CASE
VIELLE CASE
WALLHOUSE
WARNER
WESLEY
WOODFORDHILL
WOTTEN WAVEN
YAMPIECE
Nationality
Select Nationality
Afghan
Albanian
Algerian
Andorran
Angolan
Argentinian
American
Armenian
Australian
Austrian
Azerbaijani
Bahamian
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Belarusian
Belgian
Belizean
Beninese
Bhutanese
Bolivian
Bosnian
Botswanan
Brazilian
British
Bruneian
Bulgarian
Burkinese
Burmese
Burundian
Cambodian
Cameroonian
Canadian
Cape Verdean
Chadian
Chilean
Chinese
Colombian
Congolese
Costa Rican
Croatian
Cuban
Cypriot
Czech
Danish
Djiboutian
Dominican
Dominican (Republic)
Ecuadorean
Egyptian
Salvadorean
English
Eritrean
Estonian
Ethiopian
Fijian
Finnish
French
Gabonese
Gambian
Georgian
German
Ghanaian
Greek
Grenadian
Guatemalan
Guinean
Guyanese
Haitian
Dutch
Honduran
Hungarian
Icelandic
Indian
Indonesian
Iranian
Iraqi
Irish
Italian
Jamaican
Japanese
Jordanian
Kazakh
Kenyan
Kuwaiti
Laotian
Latvian
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Liberian
Libyan
Liechtenstein
Lithuanian
Luxembourg
Macedonian
Malagasy
Malawian
Malaysian
Maldivian
Malian
Maltese
Mauritanian
Mauritian
Mexican
Moldovan
Monacan
Mongolian
Montenegrin
Moroccan
Mozambican
Myanmar
Namibian
Nepalese
New Zealand
Nicaraguan
Nigerien
Nigerian
North Korean
Norwegian
Omani
Pakistani
Panamanian
Papua New Guinean orGuinean
Paraguayan
Peruvian
Philippine
Polish
Portuguese
Qatari
Romanian
Russian
Rwandan
Saudi Arabian
Scottish
Senegalese
Serbian
Seychellois
Sierra Leonian
Singaporean
Slovak
Slovenian
Somali
South African
South Korean
Spanish
Sri Lankan
Sudanese
Surinamese
Swazi
Swedish
Swiss
Syrian
Tadjik
Tanzanian
Thai
Togolese
Trinidadian
Tunisian
Turkish
Turkoman
Tuvaluan
Ugandan
Ukrainian
Uruguayan
Uzbek
Vanuatuan
Venezuelan
Vietnamese
Welsh
Western Samoan
Yemeni
Yugoslav
Zaïrean
Zambian
Zimbabwean
Antiguan
Montserratian
Saint Lucian
Kittitian
Vincentian
Phone
Email Address
Re-enter Email
ID Type
Select ID Type
Passport
Social Security
Driver's License
ID Number
Next of Kin
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)
History
Student?
Health Care Worker
Working with Animals
Health Laboratory Worker
Other, specify:
Vaccination Status
Select Vaccination Status
Not Vaccinated
1st Dose
Fully Vaccinated
Unknown
Vaccine Type
Select Vaccine Type
Sinofarm
Oxford-AstraZeneca
Pfizer-BioNTech
Moderna
Johnson & Johnson/Janssen
Novavax
First Dose Date
VaccFinalDoseDate
Asthma
Diabetes
Hypertension
Cancer
AutoImmuneDisease
ChronicBronchitis
OtherConditions
Other Conditions
Date of Travel
Place of Employment
Last day at work
tempKey
UserFK
UserDate
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Age: years
Age: month