Booking Reference
Booking Reference Number
Kit Activation Code
First name
Last name
Phone
Email address
Confirm email
Date Of Birth
Type of Test
Have you received your vaccine *
Yes
No
Has it been 14 days or more since you have been fully vaccinated (NHS Administrated)?
International Travel Country Level
Date of arrival into UK
I consent to processing of my data to Randox's
Privacy Policy
I agree to the
Terms and Conditions
Please opt in for Randox Marketing to receive discounts and promotional offers
Please ensure all information recorded on this form is correct, as once submitted, it cannot be changed.
Submit