COVID-19 Home Appointment Registration

First Nameالاسم الأول  

Second Nameالاسم الثاني

Third Nameالاسم الثالث

Family Nameإسم العائلة  

Mobileالموبايل      

Genderالجنس   Please Select (يرجى الإختيار) Male (ذكر) Female (أنثى)

Nationalityالجنسية Afghanistan Albania American Samoa Andorra Angola Anguilla Antigua/Barbuda Antilles Island Arab Isreal Argentina Armenia Aruba Ascension Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia/Hercegovina Botswana Brazil British Virgin Islands Brunei Darussalm Bulgaria Burkina Faso Burma Burundi CHILE Cambodia Cameroon Canadian Cayman Islands Central African Republic Chad China Colombia Comoros and Mayotte Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba1 Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia Gabonese Republic Gambia Georgia Germany Deutsche Ghana Gibraltar Greek Greenland Grenada/Carricou Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Hawaii Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Italy Jamaica Japanese Jordanian Kazakhistanian Kenya Kirgizstan Kiribati Kuwait Laos Latvia Lebanese Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Nothing Namibia Nauru Nepal Nether Lands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Island Non Jordanian North Korea Northern Mariana Islands Norway Not Applicable Not Known Oman Pakistan Palau Palestine Palestinian Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russian Rwanda San Marino San Tone and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St Helena St Kitts and Nevis St Lucia St Pierre and Miquelon St Vincent and the Grenadines Sudan Suriname Swaziland Sweden Switzerland Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togolese Republic Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Tuvalu US Virgin Islands American Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis and Futuna Western Samoa Yemen Yugoslavia Zambia Zanzibar Zimbabwe algeria gggggggggg

COVID-19 Testاختبار COVID-19   Please Select (يرجى الإختيار) Corona Virus ( SARS-CoV-2 ) by PCR - 20 JOD Corona Virus ( SARS-CoV-2 ) by PCR - 35 JOD

Addressالعنوان  

Governorateالمحافظة Ajlun Al Salt Al-Balqa Al-Ramtha Alfuheis Amman Aqaba Azraq Ghor Irbid Jerash Karak Ma'an Madaba Mafraq Marj Al Hamam Mutah Pitra Rusifa Sahab Tafilah Zarqa

Areaالمنطقة   Please Select (يرجى الإختيار)

Preferred Dateالتاريخ المناسب  

Preferred Timeالوقت المناسب   Please Select (يرجى الإختيار) 08:00 AM - 12:00 PM 12:00 PM - 04:00 PM

Traveling Toمسافر إلى Please Select (يرجى الإختيار) Afghanistan Albania American Samoa Andorra Angola Anguilla Antigua/Barbuda Antilles Island Arab Isreal Argentina Armenia Aruba Ascension Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia/Hercegovina Botswana Brazil British Virgin Islands Brunei Darussalm Bulgaria Burkina Faso Burma Burundi CHILE Cambodia Cameroon Canadian Cayman Islands Central African Republic Chad China Colombia Comoros and Mayotte Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba1 Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia Gabonese Republic Gambia Georgia Germany Deutsche Ghana Gibraltar Greek Greenland Grenada/Carricou Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Hawaii Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Italy Jamaica Japanese Jordanian Kazakhistanian Kenya Kirgizstan Kiribati Kuwait Laos Latvia Lebanese Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Nothing Namibia Nauru Nepal Nether Lands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Island Non Jordanian North Korea Northern Mariana Islands Norway Not Applicable Not Known Oman Pakistan Palau Palestine Palestinian Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russian Rwanda San Marino San Tone and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St Helena St Kitts and Nevis St Lucia St Pierre and Miquelon St Vincent and the Grenadines Sudan Suriname Swaziland Sweden Switzerland Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togolese Republic Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Tuvalu US Virgin Islands American Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis and Futuna Western Samoa Yemen Yugoslavia Zambia Zanzibar Zimbabwe algeria gggggggggg

Flight Dateتاريخ الرحلة

Flight Timeوقت الرحلة

National IDالرقم الوطني  

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Payers / Dr. Portal
بوابة الشركات / بوابة الاطباء

Home Appointment Request
طلب فحص منزلي

COVID-19 Home Appointment
تسجيل موعد فحص كورونا منزلي

COVID-19 Drive Thru Registration
تسجيل فحص الكورونا لخدمة السيارات

Insurance Pre-Approval Request
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