Nurse Navigator Contact Request

To request free birth control pills without receiving a callback from a staff member, you can visit this link to fill out an intake form. If you would like to speak to a staff member, please continue filling out this form.

To schedule an appointment, please call our appointment line anytime Monday-Thursday from 10 am - 4 pm at 423-265-7837.

Our service area includes the following 18 counties:

If you do not live or go to school in our 18-county service area, you can reach out to your local health department for additional information and resources.
Date*

MonthDayYear
Date
Please enter your date of birth.*

MonthDayYear
Date
Age
Per state law, since you are under the age of 18, you will need to have a parent or guardian present when a Nurse Navigator contacts you.

Since we must verify a parent or guardian is present, we cannot provide information via text message or email.
County of Residence*

Bledsoe, TNRhea, TNBradley, TNSequatchie, TNFranklin, TNCatoosa, GAGrundy, TNDade, GAHamilton, TNMurray, GAMarion, TNWalker, GAMcMinn, TNWhitfield, GAMeigs, TNDeKalb, ALPolk, TNJackson, AL
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Preferred Contact Method*

PhoneTextEmail
Preferred Contact Method

PhoneTextEmailPhone, TextPhone, EmailText, EmailPhone, Text, Email
Please note - Appointments can ONLY be scheduled via phone. At this time, we are unable to schedule appointments via text or email.
Since you are under 18, we can only contact you via phone with a parent or guardian present. Choose a date and time to schedule an appointment and speak with our Nurse Navigator to learn more about birth control and reproductive health. Appointments CANNOT be scheduled via text or email. Please be sure to click submit in the bottom right corner after scheduling your appointment. *
Would you like to be signed up to receive our quarterly newsletter?*

Yes, subscribe me to the newsletter.No.
Please select a date and time to schedule an appointment with our Nurse Navigator to learn more about birth control and reproductive health. Appointments CANNOT be scheduled via text or email. After scheduling your appointment, please be sure to click submit in the bottom right corner. *
This form is no longer available!

Use the link below to schedule with our Nurse Navigator:

Nurse Navigator phone appointments
Should be Empty: