1-866-882-2573

2015 Special

Over 2,000 Reversals & Counting !

Thank you for your interest in our Lowest Pricing of the Year!

How can you take advantage of this fantastic promotion?

That’s Easy. Let’s . . . . . . . . . . . . Ask an Expert!

Q: What is my first step?

A: Complete our CONTACT Form below & click “Submit” – it’s that easy!

Q: You have my information and records. I’m ready to schedule my surgery.

A: Great! Just give us a call at 1-866-882-2573. Do not complete another form.

Q: How do I get my medical records?

A: Let us help you. Complete our MEDICAL RECORDS RELEASE electronically after submitting your information.

Q: Who will have my medical records?

A: The hospital, surgery center or physician’s office where the procedure was performed.

Q: How soon will I know if I am approved to have the surgery?

A: Once we have your information & records, we will let you know if you are approved for surgery within 24 hours.

Quotes are Only Provided once all of your information is received and reviewed by the physician. This includes your Medical Records.

*We kindly ask that you only complete this form once so that we may have the opportunity to respond to each individual in a timely fashion and provide you with the attention you deserve. Thank you.

First
Last
MM/DD/YYYY

About My Tubal Ligation

Medical / Surgical History

How You Heard About Us

Your Medical Records

Maximum upload size: 33.55MB

Acknowledgement

Please check each box in acknowledgement prior to your submission.

Thank you.

A Records Release will be provided following your submission.