Request for a Sexual/Reproductive Health Appointment

Appointment requests will be monitored during normal business hours. We will communicate with you via the method you choose on this form to schedule and confirm your appointment.

When you submit this form, it will not automatically collect your details unless you provide it yourself.

What is your preferred method of contact?

What is your preferred method of contact? Text Phone Call Email
Please provide a phone number or email depending on your choice above.
Please tell us how we can help you (select all that apply):

Please tell us how we can help you (select all that apply): I have genital symptoms and need to be tested for an infection. I do not have genital symptoms, but I would like testing for sexually transmitted infections (we do not test for herpes, this is diagnosed based on clinical symptoms only). I am interested in starting birth control (pills, shot, patch, ring). I am interested in starting birth control (implant or IUD). I think I am pregnant. I need to refill my current birth control prescription but am not due for an annual visit yet. I need an annual visit. I need a pap smear (cervical cancer screening - starts at age 21). I have a breast concern. I need something else I need something else
Which health department location would you like to visit?

Which health department location would you like to visit? 220 W Garfield Ave. Charlevoix, MI 3434 M-119 Harbor Springs, MI 95 Livingston Blvd. Gaylord, MI 205 Grove St. Mancelona, MI I would prefer a telehealth appointment – I have no complaints and need no testing that I am aware of.
Is there anything else you would like us to know?
Do you have any questions?