Entry restrictions due to Covid-19 are changing every day. So please check before you pay for the certificate that you are still eligible for entry into your chosen destination.
Please note that the information you present should be matching with your identity document.
Patient first name*
Patient last name*
I am filling this form on behalf of someone else
Your first name*
Your last name*
Your relationship with the patient*
Email Address*
Date of Birth*
Phone Number*
Full Address* As it will appear on your certificate
Postcode*
Sex on passport*MaleFemale
Passport Number We recommend providing your passport number. Some countries require this on your certificate
What is the date of the test on your positive Covid-19 test? * This is also known as the “specimen date” or “date of test”, which may be different from the date of the certificate or result. Please note that it is your responsibility to check with your destination country what their requirements are, the most common requirements are for tests to be between 11 and 90, or 180, days of travel
What is the type of test described on your positive Covid-19 certificate? * Please note that it is your responsibility to check with your destination country what their requirements are, some countries do not accept lateral flow tests PCRRT-PCRQuantitative PCRLAMPTMARapid AntigenLateral FlowAntibody
Did you need to stay in hospital overnight due to Covid-19 *YesNo
Did your symptoms of Covid-19 start more than 14 days ago? *YesNo
If you had symptoms of Covid-19, did they start more than 10 days ago? * If you didn’t have symptoms, select “yes” YesNo
In the last 48 hours have you had a fever (greater than 37.7c), felt feverish, vomiting or diarrhoea, nausea, headaches, runny nose or sneezing? *YesNo
Following your Covid-19 infection do you have ongoing breathing problems/symptoms such as shortness of breath or a dry cough? *YesNo
Are your breathing symptoms improving over time? *YesNo
What are you planning to use your Covid Recovery Letter for?Travel to the EUTravel to the USTravel to AustraliaOther
Have you had a fever or respiratory symptoms in the last 72 hours? *YesNo
Please tell us the start date of your symptoms *
Please tell us the end date of your symptoms *
Please tell us here *
Please write here if there is anything else you think we should know
Please confirm the following *I'm the patient (or) their legal guardian/representative or parentThe details entered are true and correct to the best of my knowledgeI confirm that I have reviewed the guidance of the destination, country or organization that require this information, and can confirm that it meets their requirements.I understand that my information needs to be reviewed by a doctor and my covid recovery letter can only be issued if, in their expert opinion, the doctor feels it is appropriate.I understand that if any of the information provided changes or I become unwell, I will seek a medical opinion and follow their advice on continued use of the certificate.I understand that the Covid Recovery Letter needs to be presented alongside the positive test result.
Test Result Submission *I confirm that test certificate/notification is an original and has not been edited in any way, this includes emails from the NHS.I confirm that I've reviewed the guidance of the destination, country or organization that requires this test result, and can confirm that the test and certificate needs their requirements
I confirm I agree with the terms and conditions of services
Please upload a PDF or jpg/png file of your test certificate. If you have an NHS email or text, you can send a screenshot of a photo of this. The test must have a date or full name on it. We cannot accept photos of test cassettes or text copied and pasted from email. (max file size: 20mb)
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