BAHA MAR COVID-19 RT-PCR & RD-AG Request Form

1

As part of Our Committment to Your Wellbeing, Baha Mar in partnership with Doctors Hospital provides Covid-19 RT-PCR & Rapid Antigen Testing as part of our responsibility to keep our environment safe for our Guests and Associates.

For your convenience and comfort, we provide this testing on property. Please fill out the below COVID-19 Test Registration Form to schedule your COVID-19 Test.

It is recommended that if you are completing this test for travel purposes, please schedule your test at least 24 hours in advance of your departure.

*Please note that one (1) form must be filled out per person.

All COVID-19 Testing conducted at Baha Mar is conducted by JCI-Accredited Doctors Hospital Health System.
2
Disclaimer* This field is required.
3
Are you taking this test for the purposes of travel to the United States?* This field is required.
YESNO
4
Please be advised that the CDC presently requires COVID-19 Rapid Antigen Testing to enter the United States.

Baha Mar provides complimentary COVID-19 Rapid Antigen Testing for all guests. You can book this test by clicking "Next" and selecting "Rapid Antigen".
5
Are you Scheduling an Appointment for a Rapid Antigen Test or a RT-PCR Test?Note: A rapid antigen test is acceptable by most US commercial airlines for US international travel.
Rapid Antigen
RT-PCR
6
Please note that you have selected COVID-19 RT-PCR testing. By selecting this test, and clicking "I Agree" below, you agree that the cost of this test ($112.00) is your responsibility and must be paid online prior to testing.* This field is required.If you wish to do Rapid Antigen Testing, you can do so by clicking "Back" and selecting Rapid Antigen Testing. Baha Mar provides complimentary Rapid Antigen Testing for all guests.
I Agree
7
COVID-19 RT-PCR Test Disclaimer* This field is required.
8
COVID-19 Rapid Antigen Test Disclaimer* This field is required.
9
Request Number
10
Please select the Baha Mar Hotel at which you are staying* This field is required.
Grand Hyatt
SLS
11
Please Enter Your Full Name* This field is required.NOTE: You are required to fill out one (1) form per person requiring COVID-19 RT-PCR Testing.
First Name
Middle Name
Last Name
12
Date of Birth* This field is required.
DD/MM/YYYY
Day
Month
Year
13
Gender* This field is required.
Male
Female
14
RT-PCR Price
15
Rapid Antigen Price
16
Please Enter Your Email Address* This field is required.
Enter email
Re-enter email address
17
Enter Your Contact Information* This field is required.
Primary Phone Number
Secondary Phone Number
Passport
NIB
Drivers License
Other
Legal ID Type
Legal ID Number
18
Enter Your Residential Address
Street Address (including House Number)
Street Address Line 2
City/Settlement
Island / State / Province
P.O. Box / Zip Code
The Bahamas
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
19
Next of Kin Contact Information* This field is required.
Next of Kin Name
Spouse
Parent
Child
Other
Relationship
Primary Phone Number
Secondary Phone Number
20
Nationality* This field is required.
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
21
Reason for COVID-19 Test* This field is required.
Return to Work
Travel / Departure Testing
Exposure to an individual who has tested POSITIVE for COVID-19
Exhibiting symptoms of COVID-19
Physician Referral
22
Reason for COVID-19 Test* This field is required.
Physician Referral
Workplace/Employment
Travel
Exposure to COVID-19 Positive Patient
Exhibiting symptoms of COVID-19
23
Vaccination Status* This field is required.
Fully Vaccinated
Partially Vaccinated
Unvaccinated
24
Date of Last Dose* This field is required.
DD/MM/YYYY
Day
Month
Year
25
Do you have any of the following symptoms (Abdominal Pain, Chills, Diarrhea, Dry Cough, Fatigue, Fever, Headache, Myalgia, Loss of Taste, Loss of Smell, Shortness of Breath, Vomiting)?* This field is required.
Yes
No
26
Please indicate the symptoms you are experiencing:* This field is required.
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
Abdominal Pain
Chills
Diarrhea
Dry Cough
Fatigue
Fever
Headache
Myalgia
Loss of Taste
Loss of Smell
Shortness of Breath
Vomiting
Abdominal Pain
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
YesNo
1 of 12
27
Date of Symptom Onset* This field is required.
Indicate the date that your symptoms began.
Day
Month
Year
28
Do you presently have any of the following conditions/illnesses? (select all that apply)* This field is required.
Diabetes
Hypertension
Renal/Kidney Disease
Cardiac/ Heart Disease
Pulmonary/Lung Disease
Liver Disease
Immunocompromised
Pregnancy
N/A
29
Have you had known contact with a person who is/was infected, suspected or diagnosed with COVID-19?* This field is required.
Yes
No
30
Have you traveled (including within the Bahamas) in the past 14 days?* This field is required.
Yes
No
31
Please indicate the countries/islands you visited in the last 14 days.* This field is required.
32
Date of Arrival/Return to the Bahamas* This field is required.Indicate the date that you arrived/returned to the Bahamas.
DD/MM/YYYY
Day
Month
Year
33
COVID-19 RT PCR Test Price: ${rtpcrPrice} (VAT included)

You will receive a link via email to pay electronically for your test upon submission of this request form.
34
COVID-19 Rapid Antigen Test Price: ${rapidAntigen} (VAT included)

You will receive a link via email to pay electronically for your test upon submission of this request form.
35
Select an Appointment (RT-PCR)* This field is required.COVID-19 Testing (RT-PCR and Rapid Antigen) is located in the Grand Hyatt Grand Club.
36
Select an Appointment (RT-PCR)* This field is required.COVID-19 Testing (RT-PCR and Rapid Antigen) is located in SLS
37
Select an Appointment (Rapid Antigen)* This field is required.COVID-19 Testing (RT-PCR and Rapid Antigen) is located in the Grand Hyatt Grand Club.
38
Select an Appointment (Rapid Antigen)* This field is required.COVID-19 Testing (RT-PCR and Rapid Antigen) is located at SLS.
39
Date
Date
Day
Month
Year
40
Record ID
Should be Empty: