Fees & Forms

Fees

SERVICE (effective 3/20/2022)FEE
Urine pregnancy test (available on a walk-in basis without an appointment)Free
Blood pregnancy test (includes Draw Fee)$50
Office visit (infection check, exam, breast exam, IUD removal, or bump check)$35
Well woman exam with pap$60
Well woman exam with pap, Chlamydia & Gonorrhea$80
Well woman exam with pap, Chlamydia, Gonorrhea, HIV & Syphilis$110
STI testing – exam, Chlamydia & Gonorrhea$55
STI testing – exam, Chlamydia, Gonorrhea, HIV & Syphilis$90
HIV test$25
Limited Ultrasound$30
Nexplanon implant removal$100
Herpes I -or- Herpes II testing (in addition to office visit)$25
Hepatitis B -or- Hepatitis C (in addition to office visit)$25
HPV treatment (in addition to office visit)$20-$80
Draw Fee for labwork outside of office visit with Nurse Practitioner$20

STD testing and treatment is also available for men; the same charges apply.
Call 602-305-5100 for an appointment or for prices of other lab tests.

Many factors can affect the price of an abortion, call for more information.


Forms

To create or update your patient record through our athenahealth Patient Portal,

please click on the following link:  athenahealth portal

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Personal Health History:

All clients will be asked to complete a Personal Health History form prior to receiving services. An original signed form is required for obtaining service. The forms below are provided for reference only, and completed forms will not be accepted through e-mail. Forms are available in our office; or you may print the form, complete it, and bring it with you to your appointment.

Women’s Forms:

Men’s Forms:


Release of Medical Information:

If you wish to obtain a copy of your medical record, or have a copy sent to another provider, please print the Authorization to Release Information form, complete it in full, and return it to our office in person, by e-mail to LCWCarizona@gmail.com or by fax @ (602) 870-7697. Photo identification is required. Due to HIPAA regulations, Medical Information cannot be released via e-mail, so please include the fax number for the location where you want the information sent.


One Time Credit Card Payment Authorization:

If you wish to make a one-time credit card payment for yourself or another patient, please print the One Time Credit Card Payment Authorization Form, complete it in full, and return it to our office in person, by e-mail to LCWCarizona@gmail.com or by fax @ (602) 870-7697.

We are here for you...

We're here to help you make an informed choice about your unplanned pregnancy.


8326 N. 7th Street Phoenix, AZ 85020
3516 W. McDowell Phoenix, AZ 85009
Directions 7th » Dir McDowell »

Contact Us:

Call Us: 602-305-5100
Text Us: 909-529-2035
Español: 602-269-3131

Appointments:

Schedule Appointment »

Get Directions

8326 N. 7th Street Phoenix, AZ 85020
3516 W. McDowell Phoenix, AZ 85009
Directions 7th » Dir McDowell »