First Name
*
Last Name
*
Date of Birth
*
If Female, Enter the First Day of Your Last Menstrual Period (Best Estimate)
Phone Number
*
Email Address (Alternate contact method)
*
I understand and am aware that unencrypted communication, including any 'Protected Health Information' or PHI by text or email has some level of risk of being read by a 3rd party.
I accept the risk and consent to be contacted by phone/text/email, including voicemail message from Care Net. (if you do not accept, please contact us during regular business hours and we will be happy to assist you.)
Preferred Location
*

Berkley Center
Detroit Center
Either Center
Requested Service
*
Message
Please click on the checkbox to continue
*

Request An Appointment

**Note: One of our trained staff will contact you soon to pre-screen before scheduling for an ultrasound exam.

Note: No insurance information is necessary as all services are at no cost