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FROM TIME TO TIME WE MAY NEED YOU TO SUBMIT AN IMAGE. THESE FILES GO TO AN EMAIL ADDRESS THAT IS ACCESSIBLE BY ALL STAFF. DO NOT SEND AN IMAGE IF YOU ARE NOT HAPPY WITH THIS. DO NOT SEND UNSOLICITED IMAGES. DO NOT SEND ANYTHING UNLESS YOU HAVE DISCUSSED WITH A MEMBER OF THE PRACTICE STAFF

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Which member of practice staff asked you to forward this image, we ask this as unsolicited images are deleted *

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Name of the patient *

Date of Birth of the Patient *

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Contact Us
133 St Peter's Rd, Walkinstown, D12XN9F
Ph switch 4504168 Fax 4783175

23 Old Bawn Way, Tallaght, D24 TKP0
Ph switch 4504168