Request Test Results

Use this form to request results from tests provided by UK Division of Rheumatology and Woman's Health
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Which clinic provided your test?	Rheumatology Clinic Women's Health Clinic
PATIENT INFORMATION
Patient name:	* Required Information
E-mail:	* Required Information
Date of birth:	* Required Information
Contact phone number:	* Required Information
Alternate phone number:
Healthcare provider:	Leslie Crofford, M.D. Deidra Beshear, M.D. Jackie Carey, M.D. Robert Lightfoot, MD Kristine Lohr, MD Katie McKinney, MD Robin Meek, M.D. Lisbeth Selby, M.D. Katherine Temprano, MD Mansi Shah, DO Lynne Jensen, ARNP Sharon Lock, ARNP Kittye Roberts, ARNP Elizabeth Scarbrough, ARNP * Required Information
Type of test for which you are requesting results:
Radiology	Xray CT MRI Mammography DEXA Other    -  If other, please explain:
Lab	Blood Urine Pap Smear Other    -  If other, please explain:
Other Tests	Please enter the type of test: