Support Request Form
If you need help paying for an abortion, fill out our online intake form or call 1-833-672-2310. A volunteer will contact you within 24-48 hours.
Where are you located?
city/county and state
Please select any phone safety concerns or preferences.
It is safe to leave a detailed message and identify NRAAF as the caller.
It is safe to send a text.
It is NOT safe to leave a voicemail.
It is NOT safe to send a text.
When is the best time to call?
Morning (between 9 and noon)
Afternoon (between noon and 5)
Evening (between 5 and 9)
What kind of support do you need?
If you don't have an appointment, here is a list of providers we work with:
Roanoke Planned Parenthood
Roanoke Medical Center for Women
Bristol Regional Women's Center
Charlottesville Planned Parenthood
A Woman's Choice of Charlottesville
Chapel Hill, NC Planned Parenthood
Asheville, NC Planned Parenthood
Winston-Salem, NC Planned Parenthood
Fayetteville, NC Planned Parenthood
Richmond Planned Parenthood
Richmond Medical Center for Women
A Capital Women's Health Clinic of Richmond
Virginia Beach Planned Parenthood
Peninsula Medical Center for Women
Tidewater Women's Health Clinic
Falls Church Health Care Center
Hampton Planned Parenthood
Annandale Women and Family Center
Nelson Clinic VCU
Medstar Washington Hospital Center
Planned Parenthood PPMW
CARE (Bethesda, MD)
Gynemed Health Center
A Preferred Women’s Health Center of Charlotte
A Preferred Women’s Health Center of Raleigh
A Woman’s Choice of Greensboro
A Woman’s Choice of Raleigh
A Woman’s Choice of Charlotte
Knoxville Center for Reproductive Health
How far along is the pregnancy?
Total cost of abortion
How much can you contribute?
Are you able to cover any portion of the cost yourself? Resources are limited and we are unable to pay the full cost of the procedure for every caller. Please consider how much you will be able to contribute and what other funding resources are available.
Other sources of funding
If you are receiving any additional assistance from other abortion funds, include the name of the organization and the amount pledged by each fund. Ask the clinic if a discount is available. Call the NAF Hotline at 1-800-772-9100 to find out if you qualify for assistance. They may be able to help you with a significant portion of the cost. If you are a patient at Planned Parenthood, ask about the Justice Fund.
How much do you need to close the gap in funding?
Is there anything else you want us to know about you or your situation?
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This form was created inside of New River Abortion Access Fund.