Patient Agreement to Covid Swab Test

Thank you for your enquiry about our COVID-19 PCR testing.

Before submitting your request below, please ensure that you have read and understood all requirements for travel here and for further information please check our FAQ

Patient Agreement to Covid Swab

"*" indicates required fields

Salutation*

Family Name (Surname)*

Given Names*

Date of Birth*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Type of Covid Swab Test*

Please check with your destination country if your selected test is accepted.

Do you have any respiratory symptoms?*

Respiratory Symptoms*

Cough

Fever

Runny nose

Sore throat

Do you have any medical conditions where you should not have a nasal swab?*

This includes risk of nose bleed, clotting problems, deviated nasal septum, previous nasal or base of skull fracture/injury.

Select if Yes*

What is the reason for your test?*

Reason for Travel*

Preferred Date of Appointment

What is the window period for testing before you travel as determined by your airline/destination country?:*

Copy of NRIC/FIN card*

Max. file size: 50 MB.

Copy of Passport*

Max. file size: 50 MB.

Departure flight booking reference, time and date*

Max. file size: 50 MB.

Email Address*

Contact Number*

Clinic

Agreement*

By signing this form, I agree to the following conditions set out below:

I confirm that I have provided all required documentation

I confirm that I have declared any contra-indications to undergo nasal swabbing

I acknowledge that IMC accepts no responsibility or liability for any missed flights due to inconclusive results or any other unpredictable factors that may occur (for travellers)

I understand if my Covid Swab Test returns positive, any travel will be prohibited and MOH will be notified

Signature

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We have been caring for the international community in Singapore for over 21 years.

Patient Agreement to Covid Swab

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