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Covid-19 Form

To add the Covid-Code, enter the number shown on the side of the tube beginning with "SD".

If you have any further questions about this form or how we handle your personal information, please get in touch with us via our contact form on our website.

Full Name

Gender

Date of Birth

Age

Position

Affiliation

Test Collection Date

Country

Covid-Code (Saliva) see description above

Covid-Code (Blood Antibodies) see description above

Email

I declare that the info I’ve provided is accurate & complete. I consent to Clearidium A/S collecting and storing my personal information. By submitting this form, I agree that my information may be processed in accordance with the GDPR guidelines. For more information, see Clearidium Privacy Policy.

Thanks for submitting!

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