Request Copy of Results

Request Copy of Results

Please copy and paste the required details below into an email and send to nvrl.admin@healthmail.ie

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Request for a Copy of results

NB: This is to be used for reslease of a copy of results to the original requesting source only

Requested by___________________________________________________

Contact number_________________________________________________

NVRL Lab number (if known)_______________________________________

Specimen Date_____________________

Test results required

• ___________________________
• ___________________________
• ___________________________

Patient details

Forename_____________________________

Surname______________________________

Date of Birth_______________

Hospital/Practice/Clinic name_______________________________________

Postal address for copy results

______________________________________________________________

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