COVID-19 Testing & Certificate (Updated June12)

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Antigen Test (Lateral flow) - All-inclusive price of 15000 yen for the test, consumption tax, English certificate, and consultation. This test will be conducted via nasal swab and will take 15 minutes to process. You will be leaving with a physician-signed original document in hand.

PCR Test (Real-time) - All inclusive price of 25000 yen for the test, consumption tax, English certificate, and consultation. This test will be conducted via saliva. Samples received by 12:00 noon will be processed by 18:00. Samples received in the afternoon will be processed by 9:00 the following business day. You will be receiving a PDF via email as soon as the laboratory report is ready.

For what reason do you need the test? *

COVID Clearance for Travel purposes

COVID Clearance for shortening the quarantine period

Personal / Business use only

Email *

Contact Number:

Last Name (as shown on passport) *

First Name, Middle Name (as shown on passport) *

Date of Birth (as shown on passport) *

YYYY

Passport Country of Issue. Please bring your passport to the visit.

COVID19 Vaccination Status. Please bring your vaccination records to the visit. *

Fully Vaccinated ( 2 doses for Moderna, Pfizer, AstraZeneca, Only 1 dose for Johnson&Johnson )

If you are fully vaccinated, has it been 15 days since the last dose of the shot? (Check for Yes)

Only 1 dose of the vaccine (not including Johnson & Johnson )

Not Vaccinated

Required

What country are you coming from? (If applicable)

Arrival Date and Time (If applicable)

YYYY

Time

What country are you heading to? (If applicable, please indicate layovers if any)

Departure Date and Time (If applicable)

YYYY

Time

Airport (If applicable)

Haneda

Narita

Other:

Clear selection

When would you like to visit our clinic? Time of visit to our clinic for sample collection. Available times are between 9:00-12:00 and 15:00-18:00. The clinic is closed on weekends and national holidays. *

YYYY

Time

If you have members with you requiring the same test, please indicate them here. Full name (as shown on passport) and date of birth are a requirement.

Due to infection control, patients with COVID-like symptoms are not allowed on the clinic floor. *

I agree to inform the clinic in advance if I am (we are) symptomatic on the day of the visit.

Required

I understand that if the result is positive, I will not be receiving a certificate of clearance. I agree to communicate via internet and authorize American Clinic Tokyo to communicate via internet. I understand that I will need to provide a letter with my signature for a third party to collect my results. I will not hold the American Clinic Tokyo liable for missed flights. I have read all of the above and agree to proceed in making an appointment at the American Clinic Tokyo. *

I agree to all of the above.

Required

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