Request for Results Request for Results Full Name(Required) First Name Last Name Date of Birth(Required)DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Requesting Doctor(Required)Please select requesting doctorDr Clea AlexanderDr Anita BearzattoDr Christie BryantDr Luke BrennanDr Peter ChengDr Ei-Cheng ChuiDr Prachi DadheechDr Krish DineshDr Tanya DeanDr Kate ExonDr Sandra FaragDr Mathew FindeisenDr Damian HannonDr Angela KeenDr Nicholas KokotisDr Roy KumarDr Jason LamDr Myn Wee LeeDr Angela LeiDr Kachig MalyanDr Ananya MurthyDr Jason RajakulendranDr Krishnan RasaratnamDr Alison SullyDr Joan SanDr Olivia SzwarcbergDr Sara TarafiDr Pradeep VijayanandApproximate Date Test Was PerformedDD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Phone Number(Required)Email(Required) Description of Tests Performed (blood, type of imaging)Terms and Conditions *(Required) I consent to the practice contacting me by SMS or phone for the purpose of health information and appointment reminders. (Required) I understand that this request relates to test results referred by a Bluff Road Medical doctor (Results of tests referred by hospitals and specialists need to be obtained from the referring provider) (Required) I understand that it will take 3-5 working days for my request to be actioned and results to be emailed to me
