Request Appointment | The Women's Clinic

Skip to content

Your Options
Cost
Contraception
Get in touch

Your Options
Costs
- Costs
- Costs Overview
Contraception
Get in touch

Request appointment

Medical Abortion
Telemedical Abortion
Surgical Abortion
Cost
Contraception
Get in touch

Menu

Medical Abortion
Telemedical Abortion
Surgical Abortion
Cost
Contraception
Get in touch

Friends embracing

Hands holding

Request Appointment

Please complete the information below and one of our admin team will contact you to schedule an appointment. We will call from a private number so that our calls remain confidential.

Request Appointment Original Form

First name*(Required)

Last name*(Required)

Date of Birth(Required)

Were you born in New Zealand?

Were you born in New Zealand?

Yes

No

Ethnicity*(Required)

Is English your first language?*(Required)

Is English your first language?*

Yes

No

Do you need a translator?*(Required)

Do you need a translator?*

Yes

No

What language do you need?*(Required)

Region

Address*(Required)

Phone Number

Is it safe to call you?*(Required)

Is it safe to call you?*

Yes

No

Is it safe to text you?*(Required)

Is it safe to text you?*

Yes

No

Email Address

Is it safe to email you?

Is it safe to email you?

Yes

No

Are you enrolled with a GP?*

Are you enrolled with a GP?*

Yes

No

Practice name

Name of GP(Required)

Would you like a summary letter sent to your GP?*

Would you like a summary letter sent to your GP?*

Yes

No

Booking type

Do you think you are under 10 weeks pregnant?*(Required)

Do you think you are under 10 weeks pregnant?*

Yes

No

Have you had a blood test?*(Required)

Have you had a blood test?*

Yes

No

Where did you get your blood test done?(Required)

Do you have the results of your blood test?

Do you have the results of your blood test?

Yes

No

Upload blood test results:

Max. file size: 100 MB.

Have you had a scan?*(Required)

Have you had a scan?*

Yes

No

Where did you get your scan done?(Required)

Do you have the results of your scan?

Do you have the results of your scan?

Yes

No

Upload scan results:

Max. file size: 100 MB.

Would you like counselling support before your abortion or to help with your decision-making?*(Required)

Would you like counselling support before your abortion or to help with your decision-making?*

Yes

No

I am not sure yet

Would you like to do a self-swab STI test at the same time as your blood test?*(Required)

Would you like to do a self-swab STI test at the same time as your blood test?*

Yes

No

When did you last period start?(Required)

Message

Name

This field is for validation purposes and should be left unchanged.

Alternatively, call us

And talk to one of our administrators and they can walk you through what’s expected and making an appointment.

Delivered by

Options

All your options
Telemedical abortion
Surgical abortion
Medical abortion

Costs

General costs
Funded
Private
Non-Residents
Contraception

Get in touch

Locations
Contact
Request appointment
Patient referral form

Other

All contraception
Your guide to IUDs
The Jab
The Rod
Your guide to The Pill

Terms & Conditions
Privacy Policy

Website made nice by Made Nice