If you would like to schedule an appointment or refer a patient, please complete this online form.

Family Planning Clinic:

  • Contraceptive counseling
  • Contraceptive implant insertion and removal (Implanon®)
  • IUD insertion and removal (Mirena® and Paragard®)
  • Oral contraceptives
  • Injectable Contraceptives (Depo-Provera)
  • Emergency contraception
  • Laparoscopic sterilization
  • Hysteroscopic sterilization (Essure®)

Women’s Option Clinic:

  • Surgical abortion in the first and second trimesters of pregnancy
  • Abortion services for women with pregnancies complicated by medical conditions and fetal abnormalities
  • Medical and surgical management of miscarriage
  • Pre- and post-procedure counseling and follow-up
  • Contraceptive counseling and services, including:
  • Contraception medically complicated patients
  • Insertion of IUDs and Implanon®
  • Surgical and nonsurgical sterilization
  • Patient Information

  • Please provide the first day of the patient's last menstrual period. (approximate is fine)
  • Services Requested

  • Provider Information

    If you are a provider referring a patient to us, please provide your contact information.
  • Comments

    Provide any additional information for this request.
  • E-Mail Disclaimer For UNC Health Care and All Affiliates

    PRIVACY AND SECURITY UNC Health Care is concerned about the privacy of your medical information. Because conventional e-mail is inherently insecure, confidentiality of sensitive medical information cannot be assured. Therefore, sensitive medical matters should not be communicated through e-mail. Your e-mail messages may be processed by an assistant other than your clinician. Face-to-face or telephone communication should be used instead of e-mail to discuss sensitive medical matters. The reason that e-mail is not secure is because: * E-mail sent via the Internet or other external systems can be intercepted and read. * E-mail can be accidentally sent to the wrong recipient. * E-mail deleted by a user may still be accessed through backup files. * E-mail sent and received through work may be accessed by your employer. * E-mail can be altered to reflect an incorrect sender's address. * E-mail sent to a family account may be accessed by other family members. RESPONSES Because the response time to your message can be as long as two (2) working days, e-mail should not be used for urgent medical matters that require more timely attention. E-mail is best suited for straightforward medical issues such as prescription refill or appointment requests or cancellations. We want to make sure you have gotten our e-mail reply to you. Please acknowledge e-mail from us by using the "reply" feature on your e-mail. All correspondence to us and from us will be documented in your medical record. TYPES OF MESSAGES Because e-mail is best suited for non-urgent issues, you should use it for prescription refills, request or cancellation of appointments, or simple medical questions. Sensitive issues such as the results of HIV testing, substance abuse, or mental health issues will not be addressed by e-mail. For urgent matters, call 911. For less urgent matters that are best handled by the telephone or a face-to-face encounter with your clinician, call your provider's medical office.