Schedule an Appointment Appointment Request Form Request an appointment at Choices Clinic in Stephenville Texas. Contact InformationName First Last Phone:Email: Best method for contacting you?PhoneE-MailWhen is the best time to contact you?Morning: 8am - 11amLunchtime: 11pm - 1pmAfternoon: 1pm - 5pmEvening: 6pm - 9pmAppointment Request DetailsWhich location are you requesting an appointment from?*Please Select from BelowStephenvilleHamilton CountyYoung CountyRequested Appointment Date #1 Date Format: MM slash DD slash YYYY Requested Appointment Date #2 Date Format: MM slash DD slash YYYY Requested Appointment Time of Day:Morning 9-12pLunchtime 12p-2pmLate Afternoon 4p-6pPurpose for the appointment: (Check all the apply) STI Testing Pregnancy Testing Ultrasound Any other reason that you need to schedule an appointment?How did you hear about us?Any additional information the you would like to tell us?Who are you?
