Request Free Pregnancy Testing – The Community Health Center of Lubbock

Name *

First

Last

Phone *

Email *

Have you been seen at CHCL before? *

Yes
No

Preferred Appointmetn Date and Time

Date

Time

We do not guarantee that you will be seen on the day you choose, this is based on availability. A CHCL representative will call you back to confirm appointment dates or provide alternative dates.

How did you hear about us? (Optional)