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Appointment Form for
Covid-19 Rapid Test
First Name
Last Name
Age
Phone
Email
Preferred Clinic
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Timog Ave. Quezon City Branch
Taguig City Branch
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I am not experiencing the symptoms: fever, cough, sore throat
I haven’t been in close contact with a Covid-19 patient in the last 14 days
Appointment Date
I declare that the info I’ve provided is accurate & complete
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