COVID-19 PCR Test
For Travelers

Please enter your information correctly, It will be recorded on your test result.

PCR Test

First Name:

Last Name:

Date of Birth (yyyy/mm/dd):

Gender:

Female

Male

Identification Name&Number (Optional)

Health Card # (Optional)

Address:

Postal Code:

Phone No.:

How do you want to receive your test result?

I consent to receive my test result by email

I choose to get a print at Ultima Pharmacy

reCAPTCHA

If you are human, leave this field blank.

PCR Test Application