This form is only for registration of kits purchased from Recovery4life. If you have received a test kit from a different source/supplier, please do not complete this form.

COVID-19 Test Registration Form:

Fever; dry cough; loss of taste or smell; rashes; shortness of breath; abdominal pains; fatigue; aches and pains; headaches; sore throat; diarrhoea; runny nose; sneezing.

Company details (if applicable):

Donor Details:

Donor Declaration & Consent:

I give my consent for a virus test to be carried out, in supplying this test I will provide personal information. I confirm the information provided is correct. I understand that in accordance with obligations under the General Data Protection Regulation (GDPR), Recovery4Life will process personal information about me and share this with my employer. My personal information will be used for administration and management of virus testing and this, if necessary, will involve sending the sample to a laboratory for confirmation of the results. No other service / organisation will be informed unless requested and is necessary under the exemption clauses within the General Data Protection Regulation (GDPR). I understand that a copy of this form will be passed to my employer regardless of the result and I consent to this.

Having confirmed that I have understood the donor information sheet and read this declaration, I consent to this test and confirm the information that I have provided on this form is correct.

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