COVID-19 Test Form

ATTENTION: It is VERY IMPORTANT that the information and data provided is accurate. The reports with the results will be issued with the personal data from this form (Name, Surname, Date of Birth, etc…). Please make sure that all information is spelled correctly. GALENO CLINIC WILL NOT BE HELD RESPONSABLE IF THE PERSONAL DETAILS ARE WRONGLY SUBMITTED OR MISSPELLED.


IF THE TEST IS FOR TRAVELLING REASONS, PLEASE FILL OUT THE FOLLOWING INFO ABOUT FLIGHT.