Request a Pelvic Health Appointment

Appointment Request Form

Please complete the form to request an appointment with a pelvic health specialist in Centralia, Illinois or Jefferson City, Missouri.

First Name *

Last Name *

Birth Date *

Phone *

Address *

City *

State *

ZIP *

Email Address *

Please choose your desired location:

Centralia, Illinois

Jefferson City, Missouri

Tell us about your pelvic symptoms. *

Vaginal prolapse or bulging sensation

Bladder control or urine frequency or leakage

Ongoing pelvic pain or pressure

Pain during intercourse

Other

If other, please explain.

I have read the Notice of Privacy Practices. *

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Comprehensive Pelvic Health Care

At SSM Health, we specialize in helping individuals with pelvic health issues. Our team provides care for a wide range of conditions, ensuring that each patient receives the treatment they need. Our services include:

Urinary and fecal incontinence
Bowel urgency
Inability to fully empty your bladder
Increased urinary frequency or urgency
Post-surgical pelvic concerns
Pelvic pain, pressure, vaginal prolapse, or bulging sensation
Pelvic pain during intercourse
Constipation
Bedwetting
And more