Kit Registration - this must be completed correctly.

SBS REF (this may start with cc or just be a number) - this is the reference number on your diagnostic test request form it is also on the peel off label on the top right of the form that you should stick on the tube. PLEASE ENSURE IT IS CORRECT. *

Value is required

Do you need your passport number on your results - please enter it here. PLEASE ENSURE IT IS CORRECT.

Patient First Name *

Value is required

Patient Last Name *

Value is required

Address 1*

Value is required

Address 2

Town/City*

Value is required

County*

Value is required

Country*

Value is required

Postcode - this will be given to Track and Trace if result is positive. *

Value is required

Patient Date of Birth in dd/mmm/yyyy format - ie 01/JAN/2001 *

Value is required

Date that Sample was taken in dd/mmm/yyyy format - ie 10/NOV/2020 *

Value is required

Time that Sample was taken in 24hr hh:mm format ie 14:50 instead of 2:50 *

Value is required

Patient Gender *

Your NHS number

Results email - where should your results be sent through to? *

Value is required

Contact Telephone Number - this will be used for track and trace if positive. *

Value is required

Thank you, your registration has been confirmed.

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