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Covid-19 Test Contact Form
Please fill in the information details as shown in your passport or ID card:
Type of Test (*)
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Prefered Day of Testing (dd.mm.yyyy) (*)
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Reason for testing (*)
Please choose the reason for testing
Please specify the reason (*)
Please be kind to specify the reason for the test
Travel date (dd.mm.yyyy) (*)
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Time of Travel (*)
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Last Name (*)
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First Name (*)
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Father's Name (*)
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Date of Birth (dd.mm.yyyy) (*)
Please enter your date of birth
Country (*)
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Social Security Number (optional)
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Address (*)
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City (*)
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PO Box (*)
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Provide your ID (*)
Please choose your prefered input
Identification Card ID / Passport ID (*)
Please enter your Identification Card ID or your Passport ID
Sex (*)
Please choose your sex
E-Mail (*)
Please enter a valid email address
Phone number with country prefix
(example: +302821070800) (*)
Please type your cellular phone for SMS and contact submission regarding your test results
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Consent (*)
Please let us know if you consent in us sending your results in your personal email
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Information for Patients & Visitors

Quick Contact

M.Mpotsari 76-78
73136, Chania
tel: +30 28210 70800,
fax: +30 28210 91140
email: This email address is being protected from spambots. You need JavaScript enabled to view it.

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«Με τη συγχρηματοδότηση της Ευρωπαϊκής Ένωσης»