On Demand Rapid Test

On-Demand Rapid Test

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– Step 1 of 2

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Please choose the rapid tests you would like to receive on the next page.

You will be scheduled per your request at either the Canggu, Ubud, or Jimbaran BSI clinic.

All Information Remains Confidential

Patient Name *

You will be asked to present a passport or local Identification
Accurate records insure correct medicines for the right patient

Email *

Confirm Email

Phone / WhatsApp *

Where Would You Like an Appointment? *

Jimbaran
Canggu
Ubud

When Would You Like an Appointment? *

Date

Time

IMPORTANT, Please note: we will try to give you this appointment date, but this is not guaranteed. You will be informed via return email when your appointment has been made.

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Please Choose Which Tests You Would Like to Receive *

Blood Glucose / Sugar Level (blood sample)
Blood type, with laminated wallet card (blood sample)
Cholesterol (blood sample)
CPN (Chlamydia pneumoniae) (blood sample)
Dengue (blood sample)
Hepatitis A, B, C, D, E (blood sample)
Malaria (blood sample)
Ovulation (urine sample)
Pregnancy (urine sample)
TORCH IgG & IgM (blood sample) (Includes these 4 tests below, cannot be taken singularly):
– Toxoplasma gondii (T. gondii)
– Rubella virus (Rubivirus rubellae)
– Cytomegalovirus (CMV)
– Herpes simplex virus 2 (HSV-2)
Uric Acid (blood sample)

You may choose as many as you like, and you may change them upon arrival at the clinic.

Blood Glucose / Sugar Level (blood sample)

Blood type, with laminated wallet card (blood sample)

Cholesterol (blood sample)

CPN (Chlamydia pneumoniae) (blood sample)

Dengue (blood sample)

Hepatitis A, B, C, D, E (blood sample)

Malaria (blood sample)

Ovulation (urine sample)

Pregnancy (urine sample)

TORCH IgG & IgM (blood sample)

Uric Acid (blood sample)