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Clarity Testing Clinic Appointments

All information provided below will help us in scheduling your appointment. Please fill out the form below and we will then contact you to schedule your appointment at Clarity Testing Clinic (located at 1950 Doctor’s Park Drive, Suite B, Columbus, IN).

Name(Required)

First Last

Email(Required)

Age(Required)

Birth Date(Required)

Sex(Required)

Female

Male

Phone(Required)

May we text you at this number?(Required)

Yes

After submitting this form, we will contact you to schedule your appointment. How would you prefer us to contact you?(Required)

Phone call

May we identify ourselves when contacting you to remind you of your appointment?(Required)

Yes

Marital Status(Required)

Single

Married

Separated

Divorced

Why are you visiting Clarity Testing Clinic?(Required)

STI testing

Pap smear

Pregnancy testing

Are you a repeat client for STI testing?(Required)

Yes

Do you have insurance?(Required)

Yes

Note: Please bring your insurance card if you have one. Cash and card are also accepted.

Do you know if you have been exposed to an STI?(Required)

Yes

If yes, which STI?(Required)

Have you had a new sexual partner within the last 3 months?

Yes

Please describe any possible symptoms of a sexually transmitted infection that you are experiencing.

(Such as bumps, discharge, odor, burning, pain, etc.)

Additional comments about your concerns

Appointment Instructions(Required)

I have reviewed these instructions

Please do not empty your bladder 1 hour prior to your appointment. Please come alone or have someone drop you off. We prefer to not have friends/family waiting in our reception area. Allow 1 ½ hours for your appointment.

Pregnancy Services

We provide compassionate support so clients can make informed decisions in determining their next steps.

Learn More

Testing Clinic

We provide a listening ear and positive guidance to those in need of STI testing and treatment.

Learn More

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