Emergency Contraception & Pregnancy Test Kit Intake
You can use this form to request delivery or pickup of a Bridge Collective repro kit.

Each kit contains 2 emergency contraception (EC) pills, 2 pregnancy tests, a few condoms, and informational materials about how to correctly take EC and pregnancy tests, as well as information about other reproductive health resources in the Central Texas area. If you want to learn more about EC, pregnancy tests, or other reproductive health topics, we highly recommend checking out www.scarleteen.com.

This program is entirely run by volunteers. Volunteer coordinators receive each intake, and volunteers deliver every kit. If you need EC immediately, the fastest way to get it will be going to your local pharmacy and purchasing it (everyone can purchase EC regardless of age, gender, or whether they have an ID!). You can also pick up EC from one of our pickup spots during their hours of operation; select "Pickup" in the form for more information. Our delivery volunteers do their best to get you a kit within 48 hours, but unfortunately we cannot guarantee a delivery. If you are interested in joining our team of volunteers, you can fill out a volunteer application at www.thebridgecollective.org/volunteer.

We are only able to make 1 delivery per person every 3 months. If you are finding yourself needing emergency contraception more often than that, you can get more EC or a different form of birth control at your local federally-funded birth control clinic. These clinics provide free EC and birth control to people of any age (and no parental consent is necessary for people under 18). You can find your nearest free EC and birth control clinic at https://opa-fpclinicdb.hhs.gov/.

If you have recently experienced a sexual assault or rape and need emergency contraception, another resource is Eloise House at SAFE Austin, where you can visit with a nurse and receive EC. Advocate support and crisis intervention is available at SAFE on a walk-in basis 8 a.m.–4 p.m. on Monday through Friday. No appointment necessary. Call 512.267.SAFE (7233) or text 737.888.7233 for more information.

The only information we collect about you is the information you give us in this form. If you have any issues with this form, you can reach our volunteer team at deliveryintake@thebridgecollective.org.
Do you need emergency contraception to prevent a pregnancy due to recent exposure? *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of The Bridge Collective.