Customer form for COVID-19 tests in Samedan

Please note that registrations are for persons with an appointement.

Deutsch

Select service

Title

First name

Last name

Street

ZIP

City

Gender

Date of Birth

Mobilephone

Appointment at

Reason for test

Health insurance company and insured person number (if illness is the reason)

Name and address of the employer (if this is the reason)

Passport number (if travel is the reason)

I understand that there is a charge for the COVID-19 test (you can pay with your card on site).

I have taken note of the data protection