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Blood Test Visit Request
Please use this form to request a visit for your blood test, to be used with
www.sue-phlebotomist.uk
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* Indicates required question
Are you registered with Us?
Yes
No
Maybe
Clear selection
If yes, please give us your ID. (see card)
*
Your answer
If you are not registered or have lost your number, please contact us.
bookings@sue-phlebotomist.uk
or 07585 149 476
Do you need a blood test?
Yes
No
Clear selection
Do you have a form
*
Yes
No
Required
If no, to the above question, please contact us.
bookings@sue-phlebotomist.uk
or 07585 149 476
If yes, please tick who has requested your blood test
GP
Hospital Consultant
INR (Yellow Book / Payslip)
Midwife
Private Test KIt
Other:
Is your blood test urgent?
Yes
No
Not Sure
Do you have a date in mind?
MM
/
DD
/
YYYY
Which days of the week are you available?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Other:
What time of day would you like?
Am - ( 9am - 12 midday)
PM - ( 13:00 - 16:00)
Evening - ( 17:00 - 18:30)
Any time (9:00 - 18:30)
Other:
Are you flexible with your dates?
Yes
No - must be on date selected
Other:
Submit
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