Request a Health or Counseling Appointment Name* First Last Email* Phone*How May We Help You?*Counseling ServicesHealth ServicesWomen's Health ServicesSelect Counseling Request*I would like to schedule an intake appointment.I would like to talk to a counselor about available options.Select Health Request*IllnessInjuryHealth FormImmunization/InjectionHealth QuestionAge*Select Age RangeUnder 2121 or olderIf you are 21 years or older, a pap smear is required in order for you to receive a prescription for birth control. The cost of the pap smear is $25. Payment for service can be made to the Barton College Business Office.Select Women's Health Request*Birth ControlEducationPlease arrive for your appointment with a full bladder. (A urine specimen may be required.)When Would You Like Your Appointment? Monday Tuesday Wednesday Thursday Friday Any Weekday Permission to Process Your Data* I understand that by submitting this form I am granting Barton College permission to process my personal data and to contact me with information relevant to the services or opportunities offered, either directly or indirectly, through Barton College.