The Project SAFE Teen Health Clinic Appointment Request Form

The Project SAFE Teen Health Clinic offers birth control prescriptions, STI testing, pregnancy tests, pelvic exams, and general sexual health counseling. All Teen Health Clinic services are confidential and can be accessed without parental permission.

 Click HERE to see more information about clinic hoursservices, and location.

Name *
Date of Birth *
Date of Birth
How should we contact you? *
Please make sure to leave the best form of contact in one of the fields below.
Phone *
We may be calling or texting you on this number about your appointment.
Reason for Visit (optional)

Looking for more information about clinic hours, services, and location? Click HERE to see our clinic information page.