A+ Travel Tests @ Matters of Health Medical Clinic Pre Flight Covid19 Test Information and Intake Form
Asymptomatic individuals & no close contacts within the last 7 days only.

Travellers and non-travellers, please complete this form by 9PM the day prior to your appointment. We strongly recommend you take the time to complete this at home 24 hours before your appointment.  Not having the form submitted before your scheduled appointment may delay your appointment.

By providing the following information, I hereby agree and consent to the following terms:

By submitting information through Google Forms, A+ Travel Tests and Matters of Health are not responsible for the security, privacy and reliability of this service.  If in any doubt, please contact the clinic for alternatives.  

We are providing test certification services for the purpose of travel.  No part of this service is covered by the BC Medical Services Plan.  All fees are to be paid privately.  Our responsibility is to provide a certificate of your test results as reported by the accredited lab.  We are not responsible for the use or acceptance of this certificate.  We have no control over the processing time of the samples as it is performed by LifeLabs.  There is a possibility of a delayed report. We are not responsible for the resulting delay in travel and potential additional costs. A non-refundable full payment is required to schedule the appointment.  We will allow rescheduling of your appointment 48 hours before your appointment time for no additional costs.

Your certificate in PDF will be emailed to you. Upon request, a printed copy can be available for pick up during clinic hours.  If you have any questions, please email: aplustraveltests@gmail.com

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Email *
Instructions for non-travellers:
Please fill out this intake form even if you are not travelling. Write "N/A" or "not required" for information that you are not able to provide, such as departure time. You may bring a government-issued ID in lieu of passport. PLEASE NOTE THAT WE CAN ONLY PROVIDE SERVICE TO ASYMPTOMATIC INDIVIDUALS AT THIS TIME. Please allow 7 days if you had recently tested positive or had symptoms.
Instructions for repeat customers:
Please do not fill this out more than once. If you need your personal or contact information updated, please let us know by email and confirm with us upon your appointment.
Traveler's Surname *
Surname exactly as on your passport
Traveler's Given Names *
Given Names exactly as on your passport
Date of Birth *
Date of Birth using ONLY the following format "dd MMM yyyy" eg. 21 Jan 1995. Date of birth must match your passport.
Gender *
Gender as shown on your passport
Nationality and Passport Number *
e.g. Canadian GC123456  (MUST INCLUDE NATIONALITY PLEASE). We include the passport info as a default on the medical certificate since many destinations require this . If you do not want to include your passport number and is certain that we do not need to include your passport on your certificate, please write in the blank: not required.
Personal Health Number / PHN *
WRITE N/A if you do not have a PHN. This test is private pay but the PHN may be used by the Lab to verify your identity.
Address *
Please write down your full address
Postal Code *
Email Address To Send Certificate *
The test result certificate will be emailed to this address.**PLEASE USE THE EXACT SAME EMAIL ADDRESS YOU USED TO BOOK THE APPOINTEMENT AND RECEIVED BOOKING CONFIRMATION. If you use a different email, the certificate will only be emailed to one of the email addresses you provided, but we cannot guarantee which email address will be used.
Please Enter Email Address Again *
Enter again to confirm. **PLEASE USE THE EXACT SAME EMAIL ADDRESS YOU USED TO BOOK THE APPOINTEMENT AND RECEIVED BOOKING CONFIRMATION. If you use a different email, the certificate will only be emailed to one of the email addresses you provided, but we cannot guarantee which email address will be used.
Your Mobile Telephone Number *
Just numbers E.g. 6041234567
Your Secondary Phone Number
Just in case we cannot reach you on your mobile.
Please Enter the Date of Your Appointment at A + Travel Tests *
MM
/
DD
/
YYYY
Destination *
Date and time of your flight *
MM
/
DD
/
YYYY
Time
:
Please write down the Travel Agency you booked your travel with . Write N/A if you booked the flights yourself or are not travelling. *
Which Airline or Airlines are you flying with? Write N/A if you are not travelling. *
How did you find out about our testing program? *
A copy of your responses will be emailed to the address you provided.
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