新型冠狀病毒核酸檢測登記表格(出境用) Registration Form of COVID-19 RNA Test(for outbound purposes)
新型冠狀病毒核酸檢測登記表格
Registration Form of COVID-19 RNA Test
（出境用 for outbound purposes）
檢測者個人資料 Personal Details of Examinee
註：香港身份證號碼、回鄉證號碼和護照號碼至少填寫一個、亦可填寫多於一個證件號碼。
Note: Fill in at least one of Hong Kong Identity Card Number, Home Visit Permit Number and Passport Number，or can fill in more than one document number.
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風險評估問卷 Risk Assessment Questionnaire
  1. 過去14天您曾經居住或到訪過的城市 Cities that you have lived or visited in the past 14 days:
  2. 過去14天內您有否有與新型冠狀病毒確診者緊密接觸? Have you had close contact with COVID-19 infected person in the last 14 days?
  3. 您的居住社區/工作環境有否新型冠狀病毒確診個案? Are there any confirmed cases of COVID-19 infection in the neighbourhood of your home /office?
  4. 您有以下徵狀嗎? Do you have any of the following Symptoms?
聲明Declaration
(如檢測者未滿18歲，須由家長或監護人簽署To be signed by a parent or guardian if the examinee is below 18)
DNA WeCheck Limited / Young+ Wellness
尚醫位置
銅鑼灣羅素街2-4號2000年廣場21樓全層
(港鐵銅鑼灣站A出口，時代廣場對面)
薄扶林華富道18號華富(一)邨華安樓103號舖
荔枝角長沙灣道910號安泰大廈12樓全層
(港鐵荔枝角站C出口)
聯絡我們
(+852) 2158-2198
(+852) 9601-9138
info@youngplus.com.hk
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