Phoenix Clinic Fees & Forms
| SERVICE | FEE |
| Urine pregnancy test | Free |
| Blood pregnancy test | $25 |
| Office visit (infection check, exam, breast exam, IUD removal, or bump check) |
$30 |
| Well woman exam with pap | $55 |
| Well woman exam with pap, Chlamydia & Gonorrhea | $75 |
| Well woman exam with pap, Chlamydia, Gonorrhea, HIV & Syphilis | $100 |
| STI testing – exam, Chlamydia & Gonorrhea | $50 |
| STI testing – exam, Chlamydia, Gonorrhea, HIV & Syphilis | $80 |
| HIV test | $25 |
| Limited Ultrasound | $45 |
| Herpes test (in addition to office visit) | $40 – $80 |
| HPV treatment (in addition to office visit) | $10 |
| Hepatitis B (in addition to office visit) | $20 |
| Hepatitis C (in addition to office visit) | $30 |
STD testing and treatment is also available for men; the same charges apply.
Call 602-305-5100 for an appointment or for prices of other lab tests.
Forms
All clients will be asked to complete a medical history form prior to receiving services.
Women’s Forms:
- Personal Health History (Patient information and medical history)
Men’s Forms:
- Personal Health History (Patient information and medical history)
Completion of additional forms may be required for the following Medical Services:
- Authorization to Release Information (To release information to another provider)
