ALBANY COVID-19 Test Request Form

Have you tested positive for Covid-19 in the past 7 days?

Yes No

Price

Are you booking for a corporate group/yacht/etc.? (If booking as an individual or family, please select "No") *

Yes No

Type a question

Booking for Corporate Groups/Yachts/Large groups can be made via our Albany Group Booking Form

Please select the COVID-19 Test you wish to book an appointment for:

RT-PCR Test Rapid Antigen Test RT-PCR and Rapid Antigen Test

Do you wish to have Priority RT-PCR testing *

Yes No

Are you testing as an individual or for a your travel visa requirement? *

Individual (i.e. I am paying for myself) Travel Visa Requirement (i.e. I have a Travel Visa and have pre-paid for my test)

Please Upload a Photo of your Travel Visa

Full Name *

First Name Last Name

Gender *

Male Female

Date of Birth *

Age *

Email Address (please enter twice) *

Confirmation Email example@example.com

Phone Number *

Trip ID

Secondary Phone Number *

Company Name

Residential Address *

Street Address

Street Address Line 2

City Island / State / Province

Postal / Zip Code Country

Island of Residence in the Last 14 Days *

Employment Status *

Name of Employer *

Phone Number of Employer *

Please enter a valid phone number.

Next of Kin Name *

First Name Last Name

Next of Kin Relationship *

Next of Kin Phone Number *

Please enter a valid phone number.

COVID-19 Test Request Form