Serology Vaccination Form

Validation of COVID-19 Vaccination Status

Please complete this form and we will be in touch with you within 48 hours
PRIMARY CONTACT
Full Name (as in NRIC)*
NRIC/FIN/Passport No.*
Nationality*
Gender*
Date of Birth*

DayMonthYear
Mobile Number*
Email*
Appointment confirmation will be sent to this email
Terms of Entry or Residence
Other Entry Pass / Permit / Work Visa*
Please provide a scanned copy of your ID / Entry Pass / Permit / Work Visa

Accepted filetypes are: pdf, doc, docx, jpg, jpeg, png.
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Please provide a scanned copy of your Vaccination Records / Details

Accepted filetypes are: pdf, doc, docx, jpg, jpeg, png.
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Home Address*

Street Address

Floor, Unit #, Building Name etc.

CityState / Province

Postal CodeCountry
APPOINTMENT DETAILS
Test Date and Time (First Preference) - subject to availability*
Test Date and Time (Second Preference) - subject to availability
TEST DETAILS
Please select COVID-19 Test Type

Please select your COVID-19 Test*

COVID-19 IgG/IgM Serology Validation TestValidate your COVID-19 Vaccination Status through this Serology Test. Your results will be reflected on HealthHub after 72 hours.

$80.00SGD Quantity

Location of SwabSelect this now

$70.00SGD

Subtotal

$0.00SGD

Tax

$0.00SGD

Total

$0.00SGD

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

Remarks / Special Instructions (optional)
TERMS AND CONDITIONS

1. Our team will contact you after you place the order with the confirmed appointment time.

2. Please note the preferred times are subject to availability. Speedoc will try its best to allot the time selected, but due to high demand may offer a different appointment time.
I agree to the above Terms and Conditions
Clinic Address
991C Alexandra Road
#01-13B
Singapore 119971
Should be Empty:

Validation of COVID-19 Vaccination Status