Instructions
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We do not accept high school students for Pregnancy.
We do not submit claims with your insurance. We can put you on a payment plan and you may file for reimburesment with your insurance.
Copy of confirmation must be provided to CFWH prior to first prenatal appointment.
All pregnancies must be confirmed by a medical provider. Please contact our office at 671-588-2394 to make an appointment for pregnancy confirmation.
A medical assistant will discuss the remaining ultrasounds with you.
Please provide details of each pregnancy. Start with the oldest pregnancy and end with the most recent not including the current pregnancy.
A medical assistant will help with entering additional pregnancies.
We will need the records of your previous prenatal visits. Please complete the Authorization to Release Medical Records.
Website: same page as this form.
Office: ask Medical Assistant for help.
IMPORTANT:
After submitting, wait for "THANK YOU" message before exiting page.
This section will be completed by CFWH staff.