***Requests made using this form are still accepted***
This form is intended for requesting Faecal Immunochemical Tests by staff WITHOUT access to GPTR/WCP. If you DO have access to GPTR/WCP - we encourage you to use GPTR/WCP to submit this request.
(Locations which fall within Aneurin Bevan, Cwm Taf or Hywel Dda Health board should NOT use this form - please refer to local guidance)
Please check that the information you enter on this form is correct. If the patient details do not match our records, we may not be able to accept the referral/sample.