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Clinic Information
* – these fields are required

    1. Where do patients find you?

    2. Which services are offered at your location?

Birth Control Offered

    3. What methods of contraception do you offer? (Check yes or no. If unsure, leave blank) *

    4. Describe the availability of LARC services at your location. (Check yes or no. If unsure, leave blank)

5. Describe the availability of these methods at your location

Oral Contraception
Emergency Contraception

Abortion Services

    6. Do you offer abortion?

Funding and Insurance

    7. Does this site receive public funding? (Check yes or no. If unsure, leave blank)

    8. Describe your location's acceptance of health insurance. (Check all that apply)

    9. Describe the financial assistance at your location. (Check all that apply)

Features of Your Location

    10. Which language(s) other than English are spoken at your location?

    11. Check all that apply to your location

    12. How many patients receive services at this location annually?

    13. How can we contact you with further questions?

    14. Feel free to express any comments that can be publicly displayed in Bedsider's Clinic Finder:

    15. Feel free to share any comments with the Bedsider staff. These comments will not be made public on Clinic Finder. We'd love to hear from you!