Registration

Registration

Really, We Make Getting Your IUD A Breeze, Trust Us!

Let’s Get Started!
    1. Fill Out My-IUD.com’s Convenient Registration Form Now
    2. Read My-IUD.com’s Telemed Consent Form
    3. Read the IUD Pre-Insertion Assessment Form
    4. Click the Submit Button and your information will be sent to our representatives.
    5. We Contact You Quick! (usually within an hour) To schedule your video Telemed Consultation.

Registration/Insurance Verification

I understand and agree that any information submitted will be forwarded to our office by email and not via a secure messaging system. This form should not be used to transmit private health information, and we disclaim all warranties with respect to the privacy and confidentiality of any information submitted through this form.

*Required

  • MM slash DD slash YYYY
  • I have read and agree to Telemed Consent form *
  • This field is for validation purposes and should be left unchanged.

Locations

  • 264 19th St NW Suite 2230 Atlanta, GA 30363
  • 2635 S. Cobb Dr. Smyrna, GA 30080
  • 3886 Princeton Lake Way Suite 280 Atlanta, GA 30331
  • Columbus, GA
  • Macon, GA
  • Savannah, GA
  • Athens, GA
  • Rome, GA