COVID-19 Tests at Home

Vaccination Tele-Verification

Please enter the details below and our team will get back to you with a confirmation soon.
PRIMARY CONTACT
Full Name (as in NRIC)*
NRIC/FIN/Passport No.*
Nationality / Citizenship*
Gender*
Date of Birth*

DayMonthYear
Mobile Number*
Email*
Appointment confirmation will be sent to this email
Home Address*

Street Address

Floor, Unit #, Building Name etc.

CityState / Province

Postal CodeCountry

Please select your COVID-19 Test*

Tele / Remote Testing

Vaccination Tele-VerificationValidate your COVID-19 Vaccination Status over a video call. Your status will take 5 to 7 working days to be reflected.

$50.00SGD Quantity

Subtotal

$0.00SGD

Tax

$0.00SGD

Total

$0.00SGD

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

APPOINTMENT DETAILS
Date and Time*
Additional Details
Terms of Entry or Residence*
Other Entry Pass / Permit / Work Visa*
Please provide a scanned copy of your ID / Entry Pass / Permit / Work Visa*

Cancelof
Please provide a scanned copy of your Vaccination Records / Details

Cancelof
ADDITIONAL PERSON(S) PARTICULARS
Total Number of Person(s) / Traveller(s)*
SECOND PERSON / TRAVELLER
Full Name (as in NRIC) - [Second Person]*
NRIC/FIN/ID No. - [Second Person]*
Passport / Travel Document No: - [Second Person]*
Date of Birth - [Second Person]*

DayMonthYear
Nationality / Citizenship - [Second Person]*
Terms of Entry or Residence*
Other Entry Pass / Permit / Work Visa*
Please provide a scanned copy of your ID / Entry Pass / Permit / Work Visa*

Cancelof
Please provide a scanned copy of your Vaccination Records / Details

Cancelof
THIRD PERSON / TRAVELLER
Full Name (as in NRIC) - [Third Person]*
NRIC/FIN/ID No. - [Third Person]*
Passport / Travel Document No: - [Third Person]*
Date of Birth - [Third Person]*

DayMonthYear
Nationality / Citizenship - [Third Person]*
Terms of Entry or Residence*
Other Entry Pass / Permit / Work Visa*
Please provide a scanned copy of your ID / Entry Pass / Permit / Work Visa*

Cancelof
Please provide a scanned copy of your Vaccination Records / Details

Cancelof
FOURTH PERSON / TRAVELLER
Full Name (as in NRIC) - [Fourth Person]*
NRIC/FIN/ID No. - [Fourth Person]*
Passport / Travel Document No: - [Fourth Person]*
Date of Birth - [Fourth Person]*

DayMonthYear
Nationality / Citizenship - [Fourth Person]*
Terms of Entry or Residence*
Other Entry Pass / Permit / Work Visa*
Please provide a scanned copy of your ID / Entry Pass / Permit / Work Visa*

Cancelof
Please provide a scanned copy of your Vaccination Records / Details

Cancelof
FIFTH PERSON / TRAVELLER
Full Name (as in NRIC) - [Fifth Person]*
NRIC/FIN/ID No. - [Fifth Person]*
Passport / Travel Document No: - [Fifth Person]*
Date of Birth - [Fifth Person]*

DayMonthYear
Nationality / Citizenship - [Fifth Person]*
Terms of Entry or Residence*
Other Entry Pass / Permit / Work Visa*
Please provide a scanned copy of your ID / Entry Pass / Permit / Work Visa*

Cancelof
Please provide a scanned copy of your Vaccination Records / Details

Cancelof
Remarks / Special Instructions (optional)
TERMS AND CONDITIONS

1. Speedoc will do our best to honour your selected appointment date & timing, but due to high demand, we may contact you to offer a different appointment time.

2. Patients are responsible for checking the testing window requirements of their specific event and if the clinic can meet the required timeline.

3. I authorise Speedoc to submit my particulars to the authorities for travel documentation purposes.

4. I acknowledge that my particulars submitted are accurate.

5. By proceeding, I agree that Speedoc shall not be held responsible for any delay due to inaccuracies in my submission.
*

I agree to the above Terms and Conditions
Clinic Address
8 Kaki Bukit Ave 1
#04-06
Singapore 417941
Should be Empty: