Maternity/Neonatal Partner and Parent LFD Testing Registration

This form is to register for partner or parent Lateral Flow Testing. Lateral Flow Testing is in place for partners accompanying women in labour and for parents visiting their babies in the Neonatal Unit.

1. Partner's/Parent's Name *

First Name	*
Surname	*

2. Partner's/Parent's Date of Birth *

	DD/MM/YYYY

3. Gender *

Male
Female
Both
Indeterminate

4. Address *

5. Have they previously had an appointment at Guy's or St Thomas' Hospitals? *

Yes
No
Unsure

6. If yes, what is their hospital number or NHS number?

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