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   FORM
COVID-19 TEST REQUEST

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Passer à la version française

Name and last name (passport)
Passport number

Birthdate
Month: Day: Year:


Age
Address in Costa Rica
Reason for the test
Nacionality
Tutor
Phone number
E-mail address
 
Secundary E-mail (Optional)
 
Language of the result
PDF file in?




Select the type of test you need
PCR or Antigen?




Flight Information
¡Important to know when is the right time to test!
Departure date:
<January 2022>
SunMonTueWedThuFriSat
1
2345678
9101112131415
16171819202122
23242526272829
3031
Please select the departure date


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