Submit Test Results to JRT Health Registry

Please attach only PDF, JPG/JPEG or PNG files. Each attachment must not exceed 5 MB in size.

(for followup only)
(for followup only)

Additional Test Results

#TestResultsTest NumberTest Date
1
#TestResultsTest NumberTest Date
2
#TestResultsTest NumberTest Date
3
#TestResultsTest NumberTest Date
4
#TestResultsTest NumberTest Date
5
If 'Other', please enter test name and/or results in the explanation field

Attach Test Results (PDF, JPG or PNG)

  • All attachments should be in the same folder on your PC.
  • Please attach only PDF, JPG/JPEG or PNG files.
  • Each attachment must not exceed 5 MB in size.
  • All other file types will be rejected.
  • You may submit up to 5 file attachments at one time.
  • Use the CNTL key (PC) or Command key (Mac) to select more than one file to submit.
  • Please review your attachments carefully!

Comments