COVID-19 antigen test

Pre-register to save time and protect others

Please complete the form

My identity information

Fistname *

Lastname *

Gender *

Birthday *

Health professional *

Are you a health professional ? No Yes

My contact details

Votre n° de téléphone mobile *

If you do not have a mobile phone, you can provide the number of a relative or a trusted person.

E-mail *

If you do not have an e-mail address, you can provide the one of a relative or a trusted person.

My accomodation

Accomodation *

Street *

Zip *

City *

Why am I getting tested

Please select *

I have read and accept the Conditions Générales d'Utilisation and the Politique relative à la protection des données personnelles of the website.

Reminder : In accordance with the amended law n ° 78-17 of January 6, 1978, relating to data processing, files and freedoms, you have the right to access, query and rectify data concerning you, as well as a right of opposition for legitimate reasons. If you wish to exercise these rights, you can send your request via the contact form or by mail to the following address: Pharmasoft, 19, rue de la Reine 57640 Vigy.