Coronavirus (COVID 19) Testing Form 

This form is intended to help us prioritise testing for those people who require it. It is not a substitute for a consultation with a doctor if you or your relative are unwell but it may help with access during this exceptionally busy time.

PLEASE NOTE THAT IF YOU ARE BETWEEN THE AGES OF 4 AND 39 YEARS YOU NEED TO HAVE A POSITIVE ANTIGEN TEST BEFORE FILLING OUT THE ATTACHED FORM REQUESTING A PCR TEST.

IF YOU HAVE A POSITIVE ANTIGEN TEST YOU CAN REQUEST FURTHER FREE ANTIGEN TESTS BY GOING TO THE FOLLOWING WEBSITE: https://www2.hse.ie/services/contact-the-hse/ 

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If you are helping a family member/friend by filling out this form please enter their Name/Date of Birth/Address below.