Request An Appointment aborto North Florida Women's Services

To make an appointment for an abortion, please fill out the following form.

NOTE: Florida has a 24 hour waiting period between the time of consent with the doctor and the abortion procedure. All procedures will require 2 visits to our office. — We’re sorry for this inconvenience.

You will receive a phone call from a staff member when your appointment request has been received (usually first thing early next morning). We WILL call you at the telephone number you provide – make sure you provide a number where you can receive calls. You may receive this call after business hours and if we don’t reach you, we will leave a discrete message.

You will choose a date and time for your appointment when you are speaking with the staff member. Additional information will be provided at that time regarding office policies and procedures.

We DO NOT offer procedures or follow-up appointments on the weekends.
We do have a staff member on call for urgent concerns 24/7 but you have to leave a voicemail to receive a call back.

Request An Appointment

Today's Date*
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Patient's Name*
First Last
Date of Birth*
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City of Residence*
City
Telephone Number*
Email*
Date of Last Normal Period*
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4 digit pin to be used as an identifier for confidentiality purposes*
Create your own 4 digit pin that will be used for all phone conversations to ensure patient confidentiality.
Comments or Concerns
How did you hear about us?*
- Abortion Clinics Online Directory
- Google / Bing Search
- Family Member / Friend
- Private Doctor
Protection against automated spam

Confidentiality Notice

Your information will be transmitted by secured, encrypted e-mail. Though we make every effort to keep your information secure, it is still possible that the information you provide could be captured by individuals who are engaged in illegal internet observance. By providing and submitting your confidential information, you accept the risk of sending this information by e-mail to North Florida Women’s Services personnel and agree not to hold the center or its employees liable for any damages you may incur as a result of the transfer or use of this information.

Beware of Crisis Pregnancy Centers they do not support a woman’s right to choose.