4000 Coliseum Drive,
Suite 280 Hampton,
VA 23666
704 Thimble Shoals Blvd,
Suite 500B, Newport News,
VA 23606

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


MSAFP Quad Screen

Urine Culture

Early Screen


Thyroid Levels

Blood Test



Bone Density Test


Biopsy report

Surgical Pathology


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!