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Things to know about your first appointment with us:

READ THIS FIRST: You will need to have a valid credit or debit card available to schedule your first appointment.  A $50.00, non-refundable deposit is required to secure your appointment and discourage no-shows that deprive decided patients of that time slot. The balance will be due upon arrival at the clinic. This becomes more critical as Gov. Mike DeWine says Ohio will seek to revive the ‘heartbeat bill’ if the Supreme Court overturns Roe v. Wade

Please note: Under Ohio law, our clinic is not allowed to perform an abortion if WE KNOW that any part of your reason is based on the fact that the fetus has Down syndrome or the possibility that the fetus may have Down syndrome. If we learn that any part of your reason has to do with Down syndrome, then our clinic cannot provide your abortion. (This applies only to Down syndrome and not any other condition.) 

THIS APPOINTMENT FORM IS NOT TO SCHEDULE PROCEDURES

• A photo ID (must have your picture and date of birth listed)
• A $100 non-refundable fee will go towards your procedure balance (credit card, or money order – Cash is NOT accepted).
• We accept Debit Card, MasterCard, Visa, and Discover. We accept HSA cards as long as they are underwritten by MasterCard or Visa.
• If you are a minor, you MUST bring a photo ID and a legal guardian/parent with you for your first appointment.  Parents/guardians of minors must have a photo ID (for themselves) and a birth certificate for the patient.
• If you are minor and believe the previous requirement is impossible, please call us for information regarding a “Judicial Bypass”.
• If you have questions about this policy, please call us,

On-Line Web appointment times:

• Look below for available times.  Other times may be available. Please call 330-923-4009.

If you're a minor (under the age of 18), a parent or guardian must sign a written consent at your first appointment. If this is impossible, we will talk to you about a "court bypass" for this part of Ohio law

Patient's First Name as it appears on your photo ID *

Patient's Last Name as it appears on your photo ID *

Phone Number *

Email *

Have you taken a pregnancy test? *

Yes

No

Can we identify ourselves as Northeast Ohio Women's Center if we need to call or text? *

Yes

No

Age *

Are you a returning patient? *

Yes

No

Last NORMAL menstrual period (YOU MUST BE AT LEAST 5 WEEKS BEFOR SCHEDULING YOUR FIRST APPOINTMENT.) *

Substantial funding is now available from the NAF (National Abortion Federation). Are you interested in seeking partial funding?

Yes

No

Would you like to know more about 2nd-day visit via zoom.

Yes

No

YOU CAN ONLY SELECT ONE LOCATION *

Cuyahoga Falls - Saturday 4/20 CLINIC HOURS Are: 8:00am - 11:00am, An EMAIL Will Be Sent To You.

Shaker Heights - Wednesday 4/24 CLINIC HOURS Are: 4:30pm - 6:30pm, An EMAIL Will Be Sent To You.

Additional Notes:

By submitting this online form, you consent to receiving electronic communication from us (via email). 

PLEASE MAKE SURE TO PROVIDE A  SAFE AND SECURE EMAIL ADDRESS THAT YOU FEEL COMFORTABLE RECEIVING UPCOMING APPOINTMENT INFORMATION.

If you are human, leave this field blank.