4000 Coliseum Drive,
Suite 280 Hampton,
VA 23666
12720 McManus Boulevard,
Suite 101 Newport News,
VA 23602

Request For Test Results

Want to check on a lab test and/or ultrasound results? You’re in the right spot!

Our office will respond by phone - and your test results are private. Results will never be posted or
stored on the internet

Obstetrics and Gynecology Associates of Hampton, or The Women's Bladder Center will not sell or otherwise provide your name, address or other information to any third parties.

* Fields in color or with asterisks are required.

Person Completing this Form if OtherThan Patient:

mm dd yyyy

Please check all tests for which you would like results:

Common Tests:

Pap Smear

Beta hCG

Prenatal Labs

GC/Chlamydia

MSAFP Quad Screen

Urine Culture

Early Screen

FSH

Thyroid Levels

Blood Test

Other

Mammogram

Bone Density Test

Ultrasound

Biopsy report

Surgical Pathology

Other

If you’d like a copy of this request, please print this page before clicking Submit

Click Submit when complete - the form will be e-mailed to us

Thank You!