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Lateral Flow Test Record
Please record your lateral flow test results here. Thank you
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Test Result
*
Negative
Void
Positive
Required
QR/ID Number
*
Your answer
Date of test
*
MM
/
DD
/
YYYY
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