Assure Women’s Center Online
Appointment Request
PLEASE NOTE: This is a request for an appointment, not a confirmation of appointment.
Your appointment is not confirmed until you hear from an Assure Women’s Center staff member.
FILL IN your contact information in the appointment request form below and check the box stating we
may contact you directly to confirm the appointment.
IN THE COMMENT BOX of the appointment form, please indicate what service you are
requesting an appointment for (material assistance such as diapers, formula, clothing, etc. or a
pregnancy test/ultrasound). If requesting an appointment for a pregnancy test, please include in
the comments: the first day of your last menstrual period, if you have had a pregnancy test,
pregnancy test results, and your date of birth.
PLANNING FOR YOUR APPOINTMENT
As you plan for your appointment at Assure Women’s Center, please remember:
• An on-site pregnancy test is a prerequisite for receiving an ultrasound
• Certain other criteria are required for an ultrasound
• All services are provided at no cost and are confidential
• Bring a Photo ID to your appointment
• If you must bring children to your appointment, please bring along a friend or relative to
monitor them.
WHAT TO EXPECT
When you visit our center, please allow 45 minutes to an hour for your appointment. You’ll
meet with one of our client advocates or nurses for a confidential consultation and paperwork.
While here for a pregnancy test, you will need to provide a urine sample during your
appointment. You will receive your pregnancy test results before you leave.
Don’t see a time that works for you?
If you are unable to book an online appointment request that works with your schedule or if
there are not times available, you may call us for an appointment at 616.696.HELP (4357)
