YEHS — Request Test Results
Full Name
*
First Name
Last Name
Mobile Number
*
Email
*
example@example.com
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YEHS — Request Test Results
Appointment Date
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
I would like copies of the following tests I had done with you
Chest X-ray
Blood Tests
MRI
CT Scans
Other Tests
Additional Notes / Requests for our team
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YEHS — Request Test Results
Acknowledgement
*
I am aware you will respond within the next 5 - 7 days
I confirm I am the person who made this request
I have read through the "YEHS - Data Protection, Privacy, and Subject Access Request (SAR) Guide" above
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