Blood Test Request Form

Patient Name

Patient Date Of Birth

Contact Telephone Number

First Line of Address

Name of GP

Reason for request

Please note requests will take up to 48 working hours not including weekends

Email Confirmation

Click here if you would like to receive an e-mail confirming the form has been received by The Chestnuts Surgery.

Privacy Protection

Information submitted through secure forms is used only for the purposes of processing your request. We may be in touch with you in relation to the information submitted.

All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

I consent to my information being used for the purposes described above and wish to submit this online form to The Chestnuts Surgery • 70 East Street, Sittingbourne, Kent , ME10 4RU.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.

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Key Information

Blood Test Request Form

Privacy Protection