[% # INCLUDE dumper.tt dump = session %] [% # INCLUDE dumper.tt dump = request %] [% # INCLUDE dumper.tt dump = params %] [% PROCESS headers.tt; # sets header # INCLUDE dumper.tt dump = header %]
[% header.lab_name %] Request Form

Request IS for clinical trial

Request is NOT for clinical trial

NHS number: [% IF errs.nhs_number %]invalid[% END %]
[% INCLUDE nhs_number_ajax.tt %]