Medical Abortion Booking Form

MAKE SURE YOU HAVE READ ALL THE INFORMATION ABOUT MEDICAL ABORTIONS AT OUR CLINIC ON OUR “MEDICAL ABORTION PAGE”

Mifegymiso: You will need to be 10 weeks or less from the first day of your last period on the day that we are able to see you. ($325.00)

Methotrexate/Misoprostol: You will need to be 7 weeks or less from the first day of your last period on the day that we are able to see you. ($100.00)

If you feel you will qualify for the appointment please fill out the form below.

We will try to contact you at least 3 times throughout the next business day. (Mon – Fri) If we do not reach you please try and call us.
604-709-5611

We are usually booking within a few days so will do our best to respond promptly.

Booking Form:

Name:*

Please contact me on this number:*

First day of last menstrual period (LMP)*:
/

PLEASE MAKE SURE TO HAVE YOUR BC MEDICAL CARD NUMBER WITH YOU WHEN WE CALL (If you have one)

 


Suite 1013 – 750 West Broadway Vancouver BC V5Z 1H9
Ph. : 604-709-5611
Fax : 604-873-8304
Email: willowwomensclinic@yahoo.ca