- You have never been a patient in the Fibroid Program, OR
- You have been a patient in the Fibroid Program but are seeking an appointment with a new clinical area or doctor
After you submit the form, a representative will call you back with the information you’ll need to make an appointment. You may also speak with a representative directly Monday–Friday, 8:30 am to 5:00 pm EST by calling 857-238-4733.
Important note: Some questions on this form may appear or disappear based on your responses.
* indicates a required field.
Please call 911 if you are experiencing a medical emergency.