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at York Hospitals

Request Forms

Samples MUST be accompanied by a completed request form from the requesting clinician/GP from the York and Scarborough area. Details on this form will include:

  • Your details: name, date of birth and address – please check these are correct.
  • Your Doctor/Clinicians name and location where the results should be returned to.
  • The test that is requested (fertility semen analysis or post-vasectomy semen analysis).
  • A space for you to complete the date and time of sample production.
  • Request forms for post-vasectomy analysis may also have prompts for you to complete the abstinence period, whether the sample is complete and to confirm that the sample has been produced after a minimum of 12 weeks post surgery AND a minimum of 20 ejaculates.
  • The request form should be placed into the pocket of the sealable bag provided, not sealed in the pocket with the sample. (In case of any leaking)

Please note: GP requests for semen analysis tests should be requested for you from your GP practice that you are registered at, not your partners' details or GP practice. This may lead to your sample being rejected. 

Examples of Request Forms

Sample-ICE request forms potsRequest Forms images

Your questions answered...

Q: Frequently Asked Questions (FAQs) - Patients

Can I rearrange/cancel my booking

Yes, the page to do so is found here (Cancel Booking). Cancellations can be done online up 3 days before your appointment. After this time you will need to contact the laboratory on 01904 726258 where a member of staff can help you.

What if I turn up early or late for my booking?

Your sample may be rejected if it exceeds its hour as other specimens may be being dealt with/or are expected. Please call the lab on 01904 726258 if you think you may be early or late and we will try our best to accommodate you where possible.

What if I don't make a booking?

Any specimens without bookings will be rejected. If you are having difficulties booking a slot, please call the lab on 01904 726258 who will be happy to accommodate where possible.

What if I fail to turn up?

We urge you not to do this where possible. If you cannot attend at short notice for any reason, please call the lab on 01904 726258. We are a busy laboratory with minimal staff and Andrology is not our sole investigation.


All other definitions/terminology seen on your information sheet/request form can be found here. (Definitions/Terminology)

Q: Frequently Asked Questions (FAQs) - Clinicans/GP

How do I check I am giving my patient the correct pot and information sheet?

Toxicity tested pots have an additional white label on them. A visual example of these are found here.

These pots are usually accompanied with an information sheet.  You should ensure that the information sheet is up to date as they are reviewed regularly. Information sheets can be found here.

Where do we get the request forms from?

An ICE request form can be generated through the ICE system. Currently, we still require a printed copy to be given to the patient. 

Purple topped Histology/Cytology or a Post Vasectomy forms can also be filled out. Examples of all 3 can be found on the Request Forms tab.

How can we order toxicity tested pots?

You can either call the laboratory on 01904 726258 or email 

Where can we find information sheets?

A link to the information sheets can be found in the Information Sheets tab at the top of each website page. They can also be found on the ICE system and on the trust web page.


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Coronavirus - useful information

The latest health information about Coronavirus can be found at  Information about our local services can be found on this website here.

From Monday 15 June 2020, visitors and outpatients coming into our hospitals will be asked to wear a face covering at all times, to help us reduce the spread of Covid-19.  A face covering can be as simple as a scarf or bandana that ties behind the head.  It should cover your mouth and nose while allowing you to breathe comfortably.  For more information click here.

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