Schedule An Appointment

To request an appointment for an abortion, please fill out the following form. After requesting an appointment online, we will contact you as soon as possible, usually by the next morning. If you have not heard from us after 24 hours, please contact us.

Please note: If you are requesting an appointment on a Sunday for the next day, Monday, we might not have enough time to confirm your appointment. Feel free to come in, however. We can almost always accommodate you. You are, of course, welcome to call us after 8:00 AM to confirm your appointment.

Confidentiality Notice
The information asked online is no different than what you would be asked over the telephone. 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 Summit Centers' personnel. When submitting by e-mail, you also agree not to hold Summit Centers, including its employees or agents, liable for any damages you may incur as a result of the transfer or use of this information.

Patient's First Name *

Patient's Last Name *

Patient's Date of Birth *

Preferred Method of Contact Phone Email

Patient's Phone Number *

Patient's Email Address

Please Indicate Your Method Of Payment Uninsured/Self-Pay Private Health Insurance Medicaid *

Patient's Last Normal Period *

Length of the pregnancy

Which Clinic Location? *

Type of Appointment *

Requested Day *

Requested Time *

Medical Conditions Please include allergies, medications, or medical conditions

Patient Notes

How did you hear about us? *

Enter the numbers and letters you see on the right