Contact Us

You are using an outdated browser. Please upgrade your browser to improve your experience.

Ask Us Anything

Whether you want more info or are ready to schedule an appointment, fill out the form below. We’ll be in touch soon.

If you want to talk now, give us a call at 877-260-0352.

Our offices are open Monday–Friday: 7:00 a.m.–4:00 p.m. with live representatives answering phones until 5:00 p.m.
Select weekend locations: 8:00 a.m.–12:00 p.m.

North Florida & Georgia: Jacksonville, Jacksonville South, Daytona 1, Daytona 2, Tallahassee 1: Gynecology and Obstetrics Associates, Tallahassee 2: N. FL Women’s Care, Albany, Georgia, Brunswick, Georgia, and Valdosta, Georgia.
Fax: 877-260-0032

Central & South Florida: Orlando, Winter Garden-Stoneybrook, Ocala, Gainesville, and Melbourne
Fax: 877-260-0032

Tampa Bay Area: Tampa, Tampa North and Tampa Riverview
Fax: 877-260-0032

Click to download form for Authorization for Release of Medical Records or use our online form.

Patient Contact Information

First Name(Required)

First

Last Name

Last

Date Of Birth(Required)

Gender(Required)

Male

Female

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Email(Required)

Phone(Required)

Patient Insurance

Insurance Company(Required)

Policy ID Number

Is the patient the insurance holder

Yes

Appointment Details

How Did You Hear About Us?(Required)

Referring Provider Name (If Applicable)

Reason For Appointment(Required)

If you do not see your appointment type, please give our office a call at (877) 260-0352.

Please complete the Gestational Surrogate Application to take the next step.

Please complete the Egg Donation Application to take the next step.

Preferred Location(Required)

Preferred Booking Month(Required)

Our Locations

Fertility is a journey.
Getting to our offices isn’t.

Great care should never be too far away. We’re happy to offer patients many convenient locations throughout Florida and Southeast Georgia.