Request an Appointment - Adult Services

Are you interested in one of our adult preventive health services?

  • Breast & Cervical Cancer Control Program (BCCCP)
  • Sexually Transmitted Disease (STD) testing
  • Women's Preventive Health services including annual exams
  • Family planning (birth control)

To request an appointment online, please fill out and submit this form. An eligibility specialist will attempt to contact you by phone within 24 hours, excluding weekends and holidays. The eligibility specialist will make three total attempts to contact you.

All items are required unless marked optional.

Please provide information as it appears on legal documents.