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What is your reason for the visit?
ADMIN (STAFF USE ONLY)
Adult Immunizations
Ages/Stages Development Screening (ASQ)
AHV
Birth Control Reassessment (Oc's, Depo)
Blood Pressure Screening
C1st
Cholesterol Screening
College Physicals
Common Cold
CT19 (STAFF USE ONLY)
Dental (ONLY Dental Appt Schedule)
Diabetes Screening
earache
general lab (with a Doctor's order)
Gout
HC
Head Check
Hearing, Vision, Dental Screening (HVD)
Immunizations
Immunizations and HVD Screening
Influenza
Moderna Covid-19 Vaccine
Newborn Metabolic Screening (PKU)
Nexplanon insertion
Nexplanon Removal
PCMCA (STAFF USE ONLY)
Pink Eye
PPD Placement (NOT done on Thursday's)
PPD Reading
pre-employment physicals
pregnancy test
Scoliosis Screening
Shingles
Sinus Infection
Skin Rash
Sore Throat
Sports Physicals
SSI Screening
STD testing/exam
STD Treatment
TANF Family Planning Counseling
TB blood test QuantiFERON Gold
TBMV (STAFF USE ONLY)
Urinary Tract Infection
Women's Health New Patient Exams
Women's Health Return Annual Exam
WWBF
Were you referred to us? If so, who referred you?
Preferred Language - Enter 1 for English, 2 for Spanish * must be entered in order receive required forms for your appointment Idioma preferido: ingrese 1 para inglés, 2 para español * debe ingresarse para recibir los formularios requeridos para su cita
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Do you have health insurance?
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