Skip to content
Payments
Appointments
Repeat Scripts
Facebook
Search for:
Home
About
Covid
Covid Booster
PCR Test Referral
Payments
Surgery Info
Meet Our Team
Opening Hours
Location
Fees
Contact
Prepare Me
Services
Forms
Links
PCR Test Referral Request
When to get a PCR Test – Click Here
Use this form to request a PCR Test Referral.
First Name
*
Last Name
*
Email Address
*
Mobile Number
*
Date of Birth (DD/MM/YYYY)
*
PPS Number
*
Are you a patient of the Practice?
*
Yes
No
Positive Antigen Test
*
Yes
No
Tick if applicable to you
Healthcare Worker
Underlying Conditions
Are you Symptomatic?
*
Yes
No
If you are symptomatic, please describe your symptoms.
Thank you for your request. It has been sent and we will be in touch.
×
There was an error trying to send your message. Please try again later.
×
Submit
Page load link
Go to Top