Appointment Page

Things to know about your first appointment with us:

• 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.)

Please note: our waiting room area is only large enough to accommodate patients.  During your visit, you can include your support person via your cell phone or other electronic device with the following exceptions:

• The patient is a minor.
• The patient is disabled.

• A photo ID (must have your picture, name, and date of birth listed)
• A $150 non-refundable fee will go towards your procedure balance.
•  We accept Money orders, Debit cards, MasterCard, Visa, and Discover. We accept HSA cards as long as they are underwritten by MasterCard or Visa.
• 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”.

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

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

Phone Number *

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 "judicial bypass" for this part of the law in Ohio

Can we identify ourselves as Toledo Women's Center if we need to call or email? *

Yes

No

Email Address *

Age *

Date of Birth *

Have you taken a pregnancy test? *

Yes

No

The purpose of your appointment: (You may change your mind at your appointment if you so choose). *

Medical Abortion

Surgical Abortion

Uncertain

Last normal menstrual period: *

Are you a returning patient? *

Yes

No

This email will be from: toledoonlineappointments@gmail.com OR toledowomenscenter.com
Please review as important details will be included.

*

Sunday, November 30th.

Tuesday, December 2nd.

Thursday, December 4th.

Additional Notes:

If you do not receive your appointment confirmation message within 48 hours, please check your Spam or Bulk E-Mail folder just in case the confirmation email got delivered there instead of your inbox. If so, select the confirmation message and mark it Not Spam, which should allow future messages to get through.

By submitting this online form, you consent to receiving electronic communication from us (via email) containing confirmation and reminders about the date and time of your online appointment. When completing this form, please make sure to provide a safe and secure email address that you feel comfortable receiving reminders about your upcoming appointment.

If you are human, leave this field blank.