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   FORM
COVID-19 TEST REQUEST

Cambiar a la version en español

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
The test result will be sent to the email provided
 
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:
<August 2022>
SunMonTueWedThuFriSat
123456
78910111213
14151617181920
21222324252627
28293031
Please select the departure date


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