Test results request form – Furlong Medical Centre

Fill in the form below to request your test results.

Your details

First name(Required)

Surname(Required)

Date of birth(Required)

Sex(Required)

Male

Female

Other

NHS number(Required)

Get help to find your NHS number online

Your postcode(Required)

The one used to register with your GP.

Contact number(Required)

This phone number will be used for all correspondence relating to this request.

Your email(Required)

This email address will be used for all correspondence relating to this request. Please be aware that if you have given anyone else access to your email account they may see responses sent to you.

Enter Email Confirm Email

How would you prefer to receive your test result?(Required)

Telephone

No preference

Your test information

Your test date(Required)

What test results are you waiting for?(Required)

Not for urgent medical help(Required)

Yes, I understand this form is NOT for urgent medical help