You are here: Appointments

For Quicker and More Convenient Appointments
Before your appointment download and complete your information form and bring it with you to the clinic.

Pregnancy Form   STD Form

Birth Choice Health Clinics Appointment Request
Please fill out our simple appointment request form. Someone from our staff will confirm a specific appointment time with you based on your preferences and our appointment availability. Note that an * is used to indicate required fields.

If you need to schedule a next day appointment, please call your local clinic.
CLICK HERE for clinic hours and phone numbers.

* Please select the service that you need:     select a service STD Testing Pregnancy Testing Ultrasound Consult Abortion Information Options Consultation Support Services and Referrals
Date of last menstrual period:       (format: mm/dd/yyyy)
* Select a location that is most convenient for you:    select a location Long Beach, CA Mission Viejo, CA Napa, CA Orange, CA Placentia, CA Santa Ana, CA
* Select a day and a time range that is nearest to your preference:    Day:  select a day and date    Time:  select a time
* Name:
* Date of Birth:	(format: mm/dd/yyyy)
* Gender:	select a gender Male Female
* Preferred Language:	select a language English Spanish Vietnamese
* Contact Preference:	Email      Phone
E-mail:
Phone:
* If we need to contact you for any reason, how would you prefer we identify ourselves?:    Birth Choice Health Clinics     Doctor's Office     Jesse      Do not contact me by phone
* How did you hear about our web site?    select a type Friend Google.com Yahoo.com School Ad Yellow Pages Other