This online form is for your DAY 1 ABORTION CONSULTATION ONLY. To schedule a PAP Exam, please call us at 419-478-6801.


  • COST: An initial consultation is $50.00 (which will go towards the cost of your abortion). This fee is non-refundable and must be paid when you arrive for your first appointment. We accept cash, credit card, or debit card. We do not accept checks, money order, or American Express. Credit cards are ONLY accepted with cardholder present.
  • IDENTIFICATION: Please bring your Driver’s License or State Picture ID with you. (Minors: You must also bring your birth certificate.)
  • PARKING: There is a parking lot in the back of the building.
  • GUESTS: You may bring one support person, but we do not have public restrooms for them. Please let them know that only the patient is allowed beyond the lobby. No children are allowed.
  • DURATION: Expect to be with us for 2 to 3 hours during your first appointment.
  • MINORS: If you are under 18, your parent or guardian does not have to stay for the entire visit. Your parent or guardian must bring their Driver’s License or State Picture ID with them.
  • INTERPRETER: If you have a language barrier, you are required to bring a female interpreter with you to your first visit. Male interpreters are not allowed.

please fill out the form below and click the "Submit" button.

Note: Before clicking the "Submit" button, please write your appointment time down, as we do not send confirmation emails. We also do not confirm appointments over the phone, due to patient confidentiality.

Name *
Phone Number *
Phone Number
If you are less than 18 years old, a parent or guardian must come with you for the 1st appointment. If this is not possible, Ohio law requires that you obtain a "judicial bypass." Also, don't forget to bring your birth certificate with you to your 1st appointment.
First day of your last menstrual period: *
First day of your last menstrual period:
Have you taken a pregnancy test? *
Are you a previous patient? *
If you answered YES, please enter your date of birth.
If you answered YES, please enter your date of birth.
Appointment dates are updated on a weekly basis. If you would like to schedule your appointment more than a week out, you will need to schedule by phone.