Reasoned request to collect Radiology reports and images, through postal delivery - patients not registered in the National Health Service and/or without a Tax Identification Number

Fields marked with an asterisk (*) are mandatory.

The undersigned, aware of the penal sanctions in case of false declarations, referred to in art. 76 of Presidential Decree no. 445/2000, as owner of the radiological report/imaging:

ENTER THE DATA OF THE PERSON WHO UNDERWENT THE MEDICAL EXAMINATION