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Part 1: Skin Patch-Test Booking

Questions 1–4

Complete the form below.
Write ONE WORD AND/OR A NUMBER for each answer.

Lindenrow Dermatology: patch-test booking form
Name: Amelia Brown
Reference: [1] ____________________
Appointment day: [2] ____________________
Time: [3] ____________________
Street name: [4] ____________________

Questions 5–10

Complete the table below.
Write NO MORE THAN TWO WORDS for each answer.

Patch test: information

Topic Notes
Before the test Avoid using [5] ____________________
Test location Patches are placed on the [6] ____________________
On the day Do not apply [7] ____________________
While patches are on Avoid swimming and the [8] ____________________
Cost Fee: £ [9] ____________________
Reminders By [10] ____________________