Blood Test Results

Please complete the form below prior to your appointment for blood tests.

Name

First Name

Last Name

Date of Birth

YYYY

Please allow at least 10 days before contacting us for your blood results. Please note that some tests may take longer to come back.

If your results are required for a hospital appointment, please add the consultant’s name and speciality here:

I consent to Tuam Family Practice contacting me by text/email/phone regarding my blood results.

I consent to Tuam Family Practice contacting me by text/email/phone regarding appointments and clinic updates.

Phone

(###)

###

####

Emergency Contact Name

In the case of an urgent abnormality where we cannot contact you directly, please provide a next of kin that we can contact in the case of an emergency.

Emergency Contact Phone Number

Blood Test Results

Please complete the form below prior to your appointment for blood tests.

Address

Contact

Hours

Blood Test Results

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Please complete the form below prior to your appointment for blood tests.

Address

Contact

Hours