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?