Gulf Coast State College | Sonography OB Appointment Worksheet

Sonography OB Appointment Worksheet

If you see this don't fill out this input box.

Name - First and Last (Required)

Phone # with area code (Required)

Are you at least 18 weeks pregnant? (Required)YesNo

Date of Last Menstrual Cycle (Required)

Please be as accurate as you can be

Doctor or Office Name (Required)

Last Dr. Appointment (Required)

Last Ultrasound (Must have had an ultrasound with Dr. office before coming to GCSC) (Required)

Approximate Due Date (Required)

Are you allergic to latex? (Required)YesNo

Email (Required)

If you or someone who resides with you begin to show symptoms of Covid/Flu/Cold after we have scheduled your appointment, please call or email Rebecca so that we can reschedule you. 850-873-3589 or racton@gulfcoast.edu

If you need to cancel or reschedule, please call or email Rebecca to inform her as soon as possible so that we may be able to fill in the appointment with another anxious volunteer. Please do not NO SHOW, as it slows the students practice hours that are so desperately needed.