New Patient Application

INSTRUCTIONS: To request an appointment, please complete the following Fertility Questionnaire. The last section is for the male to complete. You may send it by clicking the "Submit Form" button on the last page. Please look for a reply which will request additional information in order to arrange your first visit. If for any reason you do not receive a reply, please call our office.

*Important: All fields marked with a ( * ) are required. If you have any questions regarding this form, please call us at (850) 857-3733

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Patient Testimonials

 Shauna & Jeremy,

When we decided to start our family things did not go as planned. So we sought the help of an OB/GYN in our local area. After one long year of fertility pills and two exploratory surgeries, our OB/GYN told us that she had done all that she could do. We were emotionally spent and frustrated....

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