PCR Q2-2023 – Institut Pasteur du Cambodge

Procedure to make your appointment:

1. Fill the information in the form below

2. Download and fill the Laboratory Request Form (Patient’s information part directly editable on the pdf)

3. Upload the documents requested (laboratory request form and copy of your passport)

4. Submit all documents by clicking the button "CLICK HERE please to submit your request"

5. Our team will check it and confirm your appointment.

Name *

First

Last

Date of Birth *

Gender *

Phone number *

Email address *

Email address confirmation *

Nationality *

Date of your appointment

Laboratory Request Form *

Please make sure the file size do not exceed 3 Mo

Passport *

Please make sure the file size do not exceed 5 Mo

Plane Ticket / Flight Information Details

Please make sure the file size do not exceed 5 Mo