Schedule Your First Appointment

Things to know about your first appointment with us:

THIS APPOINTMENT FORM IS NOT TO SCHEDULE PROCEDURES

• A photo ID (must have your picture and date of birth listed)
• A $150 non-refundable fee that will go towards your procedure balance (credit card, or money order – Cash is NOT accepted).
• We accept Debit cards, 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 a 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 419-478-6801.

First Name *

Last Name *

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 "court bypass" for this part of Ohio law

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

Yes

No

Email Address *

Age *

Have you taken a pregnancy test? *

Yes

No

Last normal menstrual period: *

Are you a returning patient? *

Yes

No

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

Yes

No

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

*

Toledo Friday 11/25: Our office hours are 9:00 - 1:00 An email will follow.

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.

Please tell me more about the 2nd-day visit via zoom. *

Yes

No

If you are human, leave this field blank.

After pressing the Submit button, please be patient.  We received your request for an appointment and you will see it when the page refreshes momentarily.