Covid Home Sample Collection Request Form

Center Id*

PCC Code*

Tests Offered:

1. URGENT SARS Cov 2 RT PCR for Covid 19 (8 Hrs) - Rs 1400

2. SARS Cov 2 RT PCR for Covid19 (24 Hrs) - Rs 700

(with in Delhi city limits with home sample collection)
*subject to confirmation only limited slots available

Pincode*

Preferred Date*

Preferred Slot*

Select Test*

Patient Name*

Gender*

Age*

Date Of Birth*

Mobile No*

Email*

Address*

Aadhar / Passport No*

Aadhar / Passport Doc