Are you a New patient or Established patient?

  • [[{"field_id":"10658","subrules":{"field_id":"12158","value":"Established Patient","operator":"Match"}}]]

Select the reason for this visit

  • [[{"field_id":"10659","subrules":{"field_id":"10658","value":"Pregnancy Test\/Confirmation (Free Service)","operator":"Match"}}],[{"field_id":"10659","subrules":{"field_id":"10658","value":"Prenatal Care (Billable through Insurance)","operator":"Match"}}],[{"field_id":"10660","subrules":{"field_id":"10658","value":"Baby Supplies, Formula, & Children's Clothing (Free Service)\u00a0","operator":"Match"}}],[{"field_id":"10662","subrules":{"field_id":"10658","value":"NAPRO\/Infertility (Billable through Insurance)","operator":"Match"}}],[{"field_id":"10661","subrules":{"field_id":"10658","value":"Annual Well-Woman Exam\/PAP Smears (Billable through Insurance)","operator":"Match"}}]]

What is your intention with this pregnancy ?

Would you like to schedule a clothing room appointment?

Are you currently on your menstrual cycle?

  • [[{"field_id":"10663","subrules":{"field_id":"10661","value":"Yes","operator":"Match"}}],[{"field_id":"10663","subrules":{"field_id":"10661","value":"No","operator":"Match"}}]]

Are you experiencing fertility issues and want to meet with a provider?

When was your last PAP Test?