Medical Report Request OLD

Are you enquiring for yourself or on behalf of someone else? *

Your name and relation to the patient

Name *

First

Last

Date of birth *

DD/MM/YYYY

Named GP (if known):

Email *

What type of medical report would you like?

*Due to COVID 19, we may not able to fulfil some of the services listed. Please contact Omnia Reception on 0121 506 2000 for more information.

Other medical reports not listed

Why do you need this report? *

Please note that there is a turnaround time of up to 4 weeks for Non- NHS work and SAR requests. *

I am aware I will need to check my Junk emails folder for responses from the practice *

Name

The Omnia Practice
73 Yardley Green Road, Bordesley Green, Birmingham B9-5PU ( 0121 506 2000)

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