Capture Persons Form Summary

1 Who is getting tested?

2 Sample Collection

3 Purchase

Total

You can buy multiple tests by adding a person

×

Who is getting tested

Please fill in the fields with details of the person that is getting tested.

*Note, all fields are mandatory.

Name (Surname, Firstname, Middlename) *

Gender *

Date of Birth *

Email *

Phone Number (eg. +2348033333333) *

Please provide your current address in Nigeria

Street *

City *

State *

LGA *

Name of Airline *

Date of flight *

Destination Country *

Passport Number *

Passport Issuing Country *

Cancel

EHA Clinics

Membership Plans

EHA Clinics Kano

Opening Hours

Dental Clinic

Eye Clinic

EHA Clinics Kano

Opening Hours

Dental Clinic

Eye Clinic

EHA Clinics Abuja

Opening Hours

EHA Clinics Lab Sample Collection Center, Abuja

Opening Hours

Remove from Purchase List?

You Really Want to Cancel your Purchase?

Who is getting tested

Please provide your current address in Nigeria

Who is getting tested

Please provide the adress of where you are currently staying in Nigeria

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EHA Clinics

Membership Plans

EHA Clinics Kano

Opening Hours

Dental Clinic

Eye Clinic

EHA Clinics Kano

Opening Hours

Dental Clinic

Eye Clinic

EHA Clinics Abuja

Opening Hours

EHA Clinics Lab Sample Collection Center, Abuja

Opening Hours