Request An Appointment Atlanta

Summit is still LEGALLY providing abortion care in Georgia.

Request an appointment for an abortion — fill out form or call (404) 607-0042.

After requesting an appointment online, we will contact you as soon as possible, usually by the next morning. If you have not heard from us after 24 hours, please contact us.

Appointment Atlanta

Today's Date*
MM slash DD slash YYYY
Patient's Full Name*
First Last
Patient's Date of Birth*
MM slash DD slash YYYY
Preferred Method of Contact*
- Phone
- Email
Patient's Phone Number*
Patient's Email Address*
Please indicate your method of payment*
- Uninsured / Self-Pay
- Private Health Insurance
- Medicaid
Patient's Last Normal Period*
MM slash DD slash YYYY
Type of Appointment*
Request Day*
Requested Time*
Medical Conditions: Please include allergies, medications, or medical conditions.
How did you hear about us?*
To validate this request enter the numbers and letters.

Confidentiality Notice
The information asked online is no different than what you would be asked over the telephone. Your information will be transmitted by secured, encrypted email. Though we make every effort to keep your information secure, it is still possible that the information you provide could be captured by individuals who are engaged in illegal internet observance. By providing and submitting your confidential information, you accept the risk of sending this information by email to Summit Centers’ personnel. When submitting by email, you also agree not to hold Summit Centers, including its employees or agents, liable for any damages you may incur as a result of the transfer or use of this information.