Choices Rising Required Patient Information
If you have questions regarding the proper completion of this form please email info@choicesrising.com or call us at (707) 200-8291( Monday-Friday 9:00 am and 4:00 pm PST)  for assistance.
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Welcome to Choices Rising!
This questionnaire is meant for patients that are interested in abortion pills for either current or future use.
Telehealth and Virtual care

Telehealth/Virtual care is a way of providing health care and education through communication technologies (websites, emails, video visits, text messaging, etc.) when you and your medical provider are not in the same place. 

At Choices Rising, we primarily deliver virtual care via online medical questionnaire, email, and text. 
You are NOT required to have a phone or video consultation, but can request to do so.
All you need is a phone or a computer.

If you are already a patient at Choices Rising, please email us at info@choicesrising.com, text or call (707)200-8291 (Monday-Friday 9:00 am and 4:00 pm PST).

Do you agree to our telehealth consent, terms and conditions?

Important: Please note that you will need to submit this form in order for a health care provider to review it. If you are just curious about the questions, please do not submit the form.
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This form was created inside of With Open Arms Center for Reproductive Freedom.

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