Please complete this form if you:

• think you think you need a blood test
• do not have any symptoms
• do not think you need an appointment to discuss it first

Common examples include men wishing the prostate cancer test (PSA) or people that might be concerned they have diabetes (HBA1c test).

A clinician will review your information, decide whether the test is appropriate and let you know the next steps via text message or phone call. 

We use your information to provide healthcare and update your medical record. We may share relevant information with NHS services involved in your care. For full details, please see our Privacy policy.