Our website provides helpful information about our practice, our healthcare providers and the services we provide.

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

Virginia Beach Obstetrics and Gynecology will not sell or otherwise provide your name,
address or other information to any third parties.

* Fields in color or with asterisks are required.

*Last name:

*First name:

Person Completing this Form if OtherThan Patient:

Name:

Relationship:

*Home Phone:

Work phone:

Ext:

*Email:

*Date of birth:

yyyy

*My Provider:

Please check all tests for which you would like results:

Common Tests:

Other

Name and Location of Facility:

Additional requests:

Mammogram

Name and Location of Facility:

Additional requests:

Bone Density Test

Name and Location of Facility:

Additional requests:

Ultrasound

Name and Location of Facility:

Additional requests:

Biopsy report

Name and Location of Facility:

Additional requests:

Surgical Pathology

Name and Location of Facility:

Additional requests:

Other

Name and Location of Facility:

Additional requests:

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!

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