SARS-CoV-2 Rapid Antigen Test (RAT)
Please fill out the following questionnaire in order for us to send you your results as fast as possible.

For those traveling: Please bring the ID or passport that you will be using to travel with at the time of the test.
Please note that we do NOT provide diagnostic testing for those feeling ill. We only offer travel screening for non-symptomatic patients.

We are NOT responsible if your destination does not accept antigen tests. Using "antigen test" as a search tag in addition to your country is a good way to see up to date results on google, I will also include two helpful sites below.(Please ensure that the information is not too outdated):

https://www.iatatravelcentre.com/world.php
https://travelbans.org/

Thank you for your time and helping us expedite this process.  

Med-X team

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Email *
Given Names *
Name(s) listed on your ID/Passport
Last Name(s) *
Name(s) listed on your ID/Passport
Date of Birth *
MM
/
DD
/
YYYY
Preferred way to contact you: *
Proffered Address or Number
Identification Type *
Passport/Driver's Licenses/ect.
Identification Issuer
What country,  province, or government body is your ID issued by.
Identification Number *
Travel Destination *
If you are testing for travel, please be aware not all destinations accept Antigen tests for entry.
Destination Arrival Date
If leaving blank, please note that if you are on a long flight, many countries require the test date to be 24-90 hours, so please book your test date in accordance to those requirements.
MM
/
DD
/
YYYY
 Destination Arrival Time
Time
:
I understand that I am solely responsible for ensuring that Antigen tests are an acceptable form of travel testing for my destination.
You're done. Thank you.
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