Patient Portal Contact

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Name

Adresse

Ort

Bundesstaat

ZIP/Postal Code

Land

Telefon

E-Mail

Date of Birth

Date of Service

Reason for contact

Patient Center Service Address

I would like to receive my preliminary results.

Ja

Nein

Preliminary results are applicable when one or more test ordered have not been completed and resulted.

* By selecting Yes, you approve receiving the preliminary results via email.

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