Vitality Members: Covid-19 Test Order Form

Vitality Members: Covid-19 Test Order Form

Please complete with the patient's details. Deliveries are to the UK only.
Please note this order form cannot be used for Test to Release.
First Name*
Last Name*
Vitality Membership Number*
Order 1 test per membership number
Date of Birth*

DayMonthYear
Gender*
Your Email*
example@example.com
Mobile Number*
billingAddress*

Street Address

Street Address Line 2

City

Post CodeCountry
Is shipping address same as billing address?*

YesNo
shippingAddress

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry

My Products*

COVID-19 Antibody Test [SCOV]£35.00

This is a fingerprick test to determine if you have had the virus. Results are usually available within 2 days of the lab receiving the sample. Tracked Next Day shipping is included. Arrives two working days after order placed.

Coronavirus PCR Swab Test [NCOV]£74.00

This is a test to determine if you actively have the virus now. The test is a self-administered throat and nasal swab. Results are usually available within 3 days of the lab receiving the samples. Tracked Next Day Shipping is included, and you should receive it within 2 working days from the day of the order.

Coronavirus PCR Swab Test with Courier & Collect (NCOV) £119.00

**London Zones 1-4 Only** Upgrade to our next business day Courier & Collect service where a courier will deliver your PCR Swab test, wait 20 minutes while you take your sample and then return the samples to our laboratory for analysis.

Subtotal £0.00Tax £0.00Shipping £0.00Total £0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

If you don’t want to receive relevant customer communications about our testing and services, please contact us at optout@londondoctorsclinic.co.uk.
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