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COVID-19 TEST SERVICE
𝗙𝗮𝗺𝗶𝗹𝘆 𝗠𝗲𝗱𝗶𝗰𝗮𝗹 𝗣𝗿𝗮𝗰𝘁𝗶𝗰𝗲 𝗛𝗮𝗻𝗼𝗶 is providing both COVID-19 RT-PCR test and antigen test services.
Please register using this form to get a special discount for delivery service of RT-PCR test result.
We will contact you shortly after you submit.
For emergency: Please contact our hotline 077.739.9119
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Full name - Họ và tên:
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Date of birth - Ngày sinh:
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MM
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DD
/
YYYY
Nationality - Quốc tịch:
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Address - Địa chỉ:
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Your answer
Passport number - Số hộ chiếu:
Your answer
Phone number - số điện thoại:
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Email:
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Your answer
Test required - Sử dụng xét nghiệm:
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Covid-19 Antigen Test - Xét nghiệm nhanh
Covid-19 RT-PCR Test - Xét nghiệm RT-PCR
Additional service (additional fee included) - Dịch vụ bổ sung (có phụ phí):
*
Applied only to RT-PCR test (chỉ áp dụng đối với xét nghiệm RT-PCR)
Home testing service - Dịch vụ xét nghiệm tại nhà
Result delivery service - Dịch vụ vận chuyển kết quả
Required
Note for FMP - Lưu ý cho phòng khám:
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