Monitoring Facility Application

Please fill out the form below to be listed on our website as a place for fertility treatment monitoring (transvaginal ultrasound and/or bloodwork).

Clinic Name * Required
Office Phone Number * Required
Best email for CNY to contact and get more information (office manager, practice director, etc) * Required
State * Required
Locations
Name
Street Address
Address Line 2
City
State
ZIP / Postal Code
Country
Phone
Email
Website * Required
Please select the services you offer. * Required
- Transvaginal fertility ultrasound
- Bloodwork
- Transvaginal fertility ultrasound & bloodwork
- Infusions
Do you offer same day results? * Required
- Yes
- No
Are you interested in becoming a gold star alliance member. * Required
- Yes
- No
- Need more information
As a gold star alliance member, you must agree to a monitoring package price including roughly 4-5 monitoring appointments for under $1,100 (for ultrasound and bloodwork) to self-pay patients. In exchange, gold star members receive prominent placement on our website and enhanced social media and newsletter recoginition.
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