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Are you pregnant?

Yes, I need medical abortion pills
I am not sure, but I think I am pregnant

When was the first day of your last menstrual period?

Do any of the below conditions apply to you?

I have had vaginal bleeding or spotting within the last week
I have had an ectopic pregnancy
I currently have pelvic pain or a history of pelvic pain, pelvic inflammatory disease, or had bleeding between periods,_pelvic_inflammatory_disease,_or_had_bleeding_between_periods
I currently have an IUD in place or I had an IUD in place when I got pregnant
I have had my tubes tied or other pelvic surgery
None of the above

If we need to contact you about your appointment, is it okay to say we are calling from

Yes
No, use

Do you have any of the following illnesses: an allergy to Misoprostol or Mifepristone or another prostaglandin; chronic adrenal failure; hemorrhagic disorder (bleeding disease); or inherited Porphyrias

I don't have an allergy to Misoprostol or Mifepristone or another prostaglandin; chronic adrenal failure; hemorrhagic disorder (bleeding disease); or inherited Porphyrias; chronic adrenal failure; hemorrhagic disorder (bleeding disease); or inherited porphyrias
I have one of the above mentioned diseases