Skip to content
COVID-19 Testing by Lucayan Medical Centre
COVID-19 Testing by Lucayan Medical Centre
  • Home
  • COVID Testing Form
  • Contact Us
COVID-19 Testing by Lucayan Medical Centre
COVID-19 Testing by Lucayan Medical Centre
  • Home
  • Hosting
  • Online Payment Form
  • Privacy Policy
  • Refund Policy
  • Terms & Conditions

COVID-19 Case Investigation Form (with Online Payment)

"*" indicates required fields

Step 1 of 3

33%
Name of Reporting Centre
Lucayan Medical Centre
Name of Reporting Healthcare Worker
Dr. Marcus Bethel
Hidden
MM slash DD slash YYYY

Patient Information

Name*
MM slash DD slash YYYY
Sex*
Are you a health care provider?
Address (in the last 14 days)*
House Number, Street Name, Providence, County
Email Address*
Government ID Type*

Which type of test are you taking?*
MM slash DD slash YYYY
Saturday Appointments 9am-12noon ONLY
Preferred appointment time slot*
Reason for Testing*
Asymptomatic?
MM slash DD slash YYYY
MM slash DD slash YYYY
Do you currently have any of the following symptoms?*
Do you currently have any of the following conditions?
Have you travelled in the last 14 days?*
MM slash DD slash YYYY
Were you in contact with a COVID-19 Positive person in the past 14 days?*
MM slash DD slash YYYY
Where were you in close contact?*
Are you, or have you been placed in home isolation?*
MM slash DD slash YYYY
MM slash DD slash YYYY
Have you been hospitalized?*
MM slash DD slash YYYY
MM slash DD slash YYYY
Did you visit a healthcare facility within the last 14 days?*
Have you been vaccinated?

Payment Information

Method of Payment*
Credit Card*
MasterCard
Visa
Supported Credit Cards: MasterCard, Visa
Expiration Date
 
Billing Address*

Review Your Submission

{all_fields} The totals displayed above are in Bahamian Dollars (BSD).
  • Privacy Policy
  • Refund Policy
  • Terms & Conditions
  • Hosting

Copyright © 2022 Lucayan Medical Centre Ltd.