"In the circumstances you have been required to provide a sample of your blood for analysis pursuant to Section 55BA (2) of the Road Safety Act 1958.
If you refuse to do so you may be charged with this offence and if convicted, you may be fined and will lose your licence for a minimum of 2 years.
Do you understand that?
Will you now allow a registered medical practitioner/approved health professional to take a sample of your blood for analysis?"
If still 'NO' - Offence of 'Refuse Blood Sample' is complete and a charge should be laid for that offence.
"What is your reason for refusing a sample of your blood for analysis?"