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Victoria Surgery
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Form Downloads

Return any completed forms to the surgery.

Access To Medical Records

Download the application for access to medical records form (DOCX, 16KB)

Urine Specimen Form

Download the application for Urine Specimen Form (DOCX, 15KB)

Travel Vaccination Request Form

Travel Vaccination Request Form (DOCX, 14KB)

Physiotherapy Self Referral 

Physio Self-referral poster with QR Code (DOCX, 94KB)

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Victoria Surgery

Moyle Medical Centre, Old Glenarm Road, Larne, BT40 1XH

  • 028 2826 1620
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