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Please provide as many details about your appointment as you can so that we can best assist you. DCAF is only able to provide funding once an appointment is confirmed. For a list of the clinics we work with, see our website here: 

https://dcabortionfund.org/get-help

If you have already left us a voicemail, you do not need to submit this form. Duplicate calls/inquiries are at risk of being flagged as spam. Please only submit this form once or leave us one voicemail.

This is a secure form. Your privacy is important to us, and your information will not be shared outside of our organization. A case manager will be in touch within the week if we have capacity to help.

Privacy Policy: DCAF will not share your information with third parties/affiliates for marketing/promotional purposes. By entering your phone number and responding "Yes" to text, you will be opted-in for SMS/texting from our case managers. Your carrier's messaging and data rates may apply.
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Appointment Information











Click on one of the Abortion Funds to select it as an option. To select more than one, hold down the control (Ctrl) or command (Cmd ⌘) key and click on the other names.





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The questions below are optional and will not impact our ability to fund you, but do help us better serve and understand our callers.