COVID-19 Day 2 and 8/ Test to Release (TTR) Form
Booking form for COVID-19 Day 2 PCR, Day 2 and 8 (with certificate/results)/TTR (with TTR Certificate)  at Yakub Chemist.

Please enter the e-mail that can be used for any communications, including results/certificate.

A copy of this form will also be sent to this email once submitted, sometimes this may appear in the junk/spam folder.  If you have not received your confirmation AFTER submission, please contact us and we can provide a PDF of the form you have submitted.

IMPORTANT: Please ensure ALL details are correct because these details will be used to generate your results/certificate if you attend the pharmacy for your appointment.
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Email *
Please note: We will email the reference number to the email you have provided. This will be sent during our opening hours. Please check your junk/spam folder if you do not receive your reference number. Otherwise contact us: pharmacy.fv608@nhs.net or 01162512959
OPENING HOURS: MON-FRI: 9AM-1PM, 2PM-7PM, SAT: 9AM-6PM, SUN: 10AM-4PM
Why do you require this service? *
Please speak to the pharmacist for more information. If you require both then please select complete the form twice. If you are unsure which test you require you can get more information from the Government website: https://www.gov.uk/guidance/red-amber-and-green-list-rules-for-entering-england#
Transaction ID from PayPal *
For day 2 or day 2 & 8 tests only: Please enter your Transaction ID, which you should have received in an email from PayPal after making the payment. This is so we can link your booking with the payment. If you have not made the payment then please follow the instructions on our website: https://www.yakubchemist.co.uk/community-retail-pharmacy/#covid19-testing-services
Please follow the Government guidelines and national lockdown travel rules
For the latest guidance visit: https://www.gov.uk/coronavirus
Get advice about travelling abroad, including the latest information on coronavirus, safety and security, entry requirements and travel warnings.
https://www.gov.uk/travel-abroad
Forename including middle name *
Provide full name as per passport (include middle names if applicable)
Surname *
Provide name as per passport
Date of birth (DOB) *
Click the calendar icon to select DOB. IMPORTANT: YOU MUST ENSURE YOUR DOB IS IN THE CORRECT FORMAT. If the patient is under 18 years old, a parent/guardian will need to be present for TTR
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Address *
Please include first line of address, city, and postcode in the UK where you will be in quarantine, this is where we will deliver your kits and this is also the address that will be given to NHS Test and Trace
How will you like to receive your tests? *
Delivery has no extra charge. Delivery will be to the address given above.
If you have selected delivery option, please give us additional instructions to help the courier driver e.g. deliver to neighbour
Country of residence *
Are you self isolating at your previously entered address? *
If the address is different please specify
Are you fully vaccinated with the COVID-19 vaccine? This applies if you’re fully vaccinated under either:the UK vaccination programme OR the UK vaccine programme overseas OR an approved vaccination programme in Europe or the USA - not all are recognised in England *
Find out how to prove you are fully vaccinated, which European countries this applies to and approved vaccination programmes for Europe and the USA.: https://www.gov.uk/guidance/how-to-quarantine-when-you-arrive-in-england
Has it been 14 or more days since you have been fully vaccinated (NHS Administered)?
Clear selection
UK Mobile number *
This will be used via our team to contact you about your order, provide you with delivery updates, and will be given to NHS Test and Trace
Gender *
Arrival date and time *
Click the calendar icon to select date of arrival.
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Time
:
Travel Number (Flight/Coach/Vessel) *
Passport number *
Country or Territory you travelled from when you entered the UK : *
What is your nationality? *
Any countries or territories  you transited through as part of this journey *
On the date of the test, what colour was the country or Territory you will/have travelled from when you entered the UK? *
Appointment/swab date and time
This is the date you have booked your appoint at Yakub Chemist. Click the calendar icon to select date. If you do not want to attend the pharmacy for your test then please leave this blank
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Time
:
Expected day of delivery or collection
This is the date you have booked your appoint at Yakub Chemist. Click the calendar icon to select date. If you do not want to attend the pharma would like to receive the kit either via courier or collection from the pharmacy. If you will attend the pharmacy for your test then please leave blank
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Please read the following statements and tick if you understand *
I understand
Reference numbers can only be given during our opening hours, if you complete the form and payment outside of these hours then the reference numbers will be given the next working day
Yakub Chemist can only supply post-travel tests to arrivals from NON-RED countries. The customer must check their eligibility.
Due to festive season, there won’t be any deliveries from 25/12/2021 to 03/01/2022
Yakub Chemist are not responsible for any charges incurred in the unlikely event that you do not receive your results before your expected time.
Results may be negative, positive, or unclear.
For TTR: The customer must check their eligibility to participate in the TTR and appropriately calculate their day 5. The test is non-refundable once sample is taken, irrespective of the results or circumstances. For day 2 and 8 test: The kits are non-refundable once dispatched from Yakub Chemist.
ALL results are automatically reported to Public Health England (PHE)/NHS. If you test POSITIVE you MUST self-isolate and follow the Government guidelines. You may be contacted by NHS Track and Trace.
I give consent to share my data with the Laboratory, PHE/NHS England, and the courier company for the specified processing purposes. If you test positive you may be contacted by NHS Test and Trace *
If you do not agree then we cannot proceed with the test
Required
Where did you hear about us? *
A copy of your responses will be emailed to the address you provided.
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