Activate My Kit - Biodiagnostics Ltd

First Name

Last Name

Email

PLEASE ENTER YOUR KIT ACTIVATION CODE:
(e.g: A123)

-

PLEASE CONFIRM YOUR ACKNOWLEDGEMENT AND AGREEMENT TO THE FOLLOWING:
(please use tick boxes)

I have read and understood the Waiver Declaration

I have read and understood the Test Service Terms & Conditions

I have read and understood the Instructions for use

I guarantee that any sample I send does not contain a communicable disease, (e.g. H.I.V.)

Please also answer the following questions.

Have you previously had a positive COVID19 antigen test?
If yes then give approx. date.

Have you previously had a positive COVID19 antibody test?
If yes then give approx. date.

Have you had a 1st Vaccination?

Date of 1st vaccination:

Have you had a 2nd Vaccination?

Date of 2nd vaccination:

Have you had a 3rd Vaccination?

Date of 3rd Vaccination:

Have you had a 4th Vaccination?

Date of 4th Vaccination:

Have you had a 5th Vaccination?

Date of 5th Vaccination:

Please indicate your approximate age:

Date blood sample taken:

Date blood sample sent:

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