EcoCare

First Name

Please provide a valid First Name.

Last Name

Please provide a valid Last Name.

Nationality

Please provide a valid Nationality.

Date of birth

Please provide a valid date of birth.

Gender

Divers

Institution

Please select a Institution

Institution Name

Please enter Institution name

RIZIV Code

Please enter 11 digit RIZIV Code

Identification Number

Please enter 11 digit Identification Number

Corona Test prescription Code

Please enter Corona Test prescription Code

Name of House Doctor

Please enter name of House Doctor

House Doctor Phone

Please enter Phone of House Doctor

Length of stay in departure country

Please provide a valid number of days (1 - 999)

Warum möchten Sie sich testen lassen?

Veranlassung durch das Gesundheitsamt.

Veranlassung durch einen Hausarzt.

Ich bin Reiserückkehrer.

Sonstige Gründe

Ich bin:

Studierende(r)

Hochschulangehörige(r)

andere(r)

Ich weise Symptome auf (z.B. trockener Husten, Halsschmerzen, Verlust des Geschmacks- oder Geruchssinns oder Fieber).

Nein

Identification Number

Please enter valid Personnel Number

Family member?

Yes

Work Location

Please select work location

Reason for testing?

Staff with high-risk contacts.

Pre- and post-travel for work.

Screening of staff members.

Passport Number

Please enter valid Passport Number

Airline Batch Number

Please enter valid Airline Batch Number

Departure date

Please provide a valid Departure date.

Departure time

Please provide a valid Departure time.

Destination country

Please select destination country.

Transfer passenger?

Yes

Bürger oder Flughafen Passagier?

Bürger

Passagier

Ort des Tests

Memmingen Flughafen

Nürnberger Flughafen

Ich habe Covid-19 typische Symptome wie z.B. Fieber, Kopfschmerzen, Übelkeit, Geschmacksverlust etc. oder hatte Umgang mit einer bestätigten COVID-19-infizierten Person (Kontaktperson Kategorie K1)?

Nein

Folgende Testkategorie trifft auf mich zu (bitte wählen Sie eine der folgenden Kategorien aus):

Testung symptomatischer Personen

Testangebot für Bewohner/Innen Bayerns

Testangebot für pädagogisches Personal in Kindertageseinrichtungen sowie für Lehrkräfte und Schulpersonal

Testung von Kontaktpersonen der Kategorie I

Reihentestungen zur Prävention in infektionsgefährdeten Bereichen wie Alten- und Pflegeheimen

(Anlasslose) Reihentestungen in Gemeinschaftsunterkünften

Ich gehöre zum Personal.

Ich bin ein Bewohner.

Country

Please provide a valid Country.

Street

Please provide a valid Street.

Postal Code

Please provide a valid Postal Code.

City

Please provide a valid City.

Mobile

Please provide a valid Mobile.

Please provide a valid Email.

Airport

Please provide a valid Airport.

Flight number

Please provide a valid Flight Number.

Departure date

Please provide a valid Departure date.

Departure time

Please provide a valid Departure time.

Airline

Please provide a valid Airline Company.

Place of departure

Please provide a valid Place of departure.

Arrivig from a risk country

Yes

Create 6 digit password

Please provide a valid Secret.

Please note: After you will submit form QR code will be generate and shown in next screen, using this QR you can see the result of test when ready. If you lose the QR Code you can use the following information to access the test results:

Name
Surname
Date of Birth
Six Digit Password

Thank you for completing the Application Form. You will receive a unique QR Code in the e-mail provided for a secure access to the COVID-19 Test Results.

Personal Information

Home Address

Address in the next 14 days if different to home address

Flight Information

Test type & Pay

Thank you for completing the Application Form. You will receive a unique QR Code in the e-mail provided for a secure access to the COVID-19 Test Results.

ID:

Thank you for completing the Application Form. You will receive a unique QR Code in the e-mail provided for a secure access to the COVID-19 Test Results.