Request a FREE Clinic Ride!
*Want to request a ride over the phone instead? Call us at 440-895-7544.

Do you need a ride from Oberlin to your sexual/reproductive health clinic visit? The Sexual Information Center (SIC) provides FREE rides to clinic visits for sexual/reproductive health or gender affirmation! Please fill out this form at least 3 days (72 hours) before your planned clinic visit.

This ride service is confidential. Your identifying information will be seen ONLY by the SIC and your driver. Your volunteer driver has agreed to provide non-judgmental and confidential support during transportation. You may request a ride to ANY location within reasonable driving distance from Oberlin, as long as your clinic visit relates to sexual/reproductive health and/or gender affirmation. You need not be an OC student to request a ride; rides are for anyone and everyone.

Our drivers are volunteers, and rides depend on volunteer availability. Therefore, this is not a guaranteed service. If you have questions about this ride service, email the SIC at sic@oberlin.edu or call us at 440-895-7544. For more information about the SIC, visit our website at www.oberlinsic.com, or our Facebook page at www.facebook.com/oberlin.sic/.

Thank you!
Name (optional)
Your answer
Pronouns (optional)
Your answer
Email Address *
If you don't have one, type "N/A."
Your answer
Phone Number *
If you don't have one, type "N/A."
Your answer
Is this ride related to sexual health, reproductive health, and/or gender affirmation? *
Where do you need to go? *
Please provide the clinic name and full address.
Your answer
What is the date of your appointment or clinic visit? *
MM
/
DD
/
YYYY
What time do you need to get there? *
Time
:
Do you also need a ride back to Oberlin? *
If so, how long will your appointment take?
This can be a rough estimate if you're not sure. (Example: "30 minutes to 1 hour"). This question is REQUIRED for folks who are requesting a ride back to Oberlin.
Your answer
Are you planning on going by yourself, or would you like to bring someone with you? (A friend, family member, support-person, etc.) *
Would you like your driver to accompany you into the clinic, and/or wait for you in the waiting room? *
Check all that apply. We ask this question because sometimes it's helpful to have your driver double as a clinic escort, and additionally, sometimes clinic patients are required to have someone wait for them in the waiting room, based on the nature of the services they are receiving (for example, anesthesia).
Required
Do you have any accessibility needs for the ride?
Please also tell us about any allergies you have.
Your answer
Is there anyone you DON'T want as your driver? (Your answer is confidential).
Our drivers currently include: Della Kurzer-Zlotnick, Hannah Rosenberg, Nora Hubbard, Mara Delta, Kasadi Shock, Eva Wynn, Mikael Frey, Emmanuel Navarro, Emma Downing, Rachael Hood, Suzanne Denneen, Dean Boughton, Katharine Rigdon, Lauren Cole, Arianna Crawford, Efi Narliotis, Eliot Callon, Jojo Scott, Natalie Korzh, Eliana Grosof, Nico Vickers, Emma Baker, Aniella Day, Elsa Schlensker, Etta Schaye, Elana Rosenberg
Your answer
If you are a person of color and/or a non-cis person, you can check the boxes below to let us know how we can make you most comfortable.
Check all that apply.
Anything else we should know?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Oberlin College. Report Abuse