Comprehensive Couples Package
A thorough and confidential lab test package for couples, offering a wide range of essential screenings and an in-person provider consultation—designed to give both partners peace of mind and a clear understanding of their sexual health.
Clinic Name
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Clinic Information
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Appointment Information
Appointment
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Personal Information
Name
*
First Name
Last Name
Email
*
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Phone Number
*
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Format: (000) 000-0000.
Birthdate
*
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Day
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Date
Gender
*
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Male
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Address
*
Street Address
Street Address Line 2
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Partner's Information
Partner's Name
*
First Name
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Partner's Birthdate
*
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Partner's Gender
*
Please Select
Male
Female
Partner's Address
*
Street Address
Street Address Line 2
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Lab Test Information
Package
*
Comprehensive Couples Package - $489
Gonorrhea
Chlamydia
HIV 4th gen
Herpes 1
Herpes 2
Syphilis
Hepatitis B
Hepatitis C
Trichomoniasis
Includes In Person Provider Consultation
Total Amount
Payment Amount
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Credit Card Number
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Expiration Month
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Expiration Month
Expiration Year
2026
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2028
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2030
2031
2032
2033
2034
2035
2036
2037
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2039
2040
2041
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2045
Expiration Year
Email Consent
*
I understand that my appointment confirmation will be sent to my provided email address. I acknowledge that standard email is not a fully secured channel and consent to receiving my booking confirmation this way.
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