Plan B Request

Submit a request for free Plan B!

TSU S.H.A.P.E. Initiative is offering free Plan B to both the Greater Houston Area Community and Campus.

Client must be STI screened before receiveing Plan B

Only 2 per person per year.

Public Affairs Building Room 302Q

Question please call 713-313-1975 or Nichole.akinbohun@tsu.edu
DOB*

MonthDayYear
Date
Phone Number*
Format: (000) 000-0000.
Email*
example@example.com
Note:This Plan B service is provided by solely through the TSU SHAPE Initiative Program and is not affiliated in any way with the TSU Student Health Center.
- For female aged 18+ consumption only
- May cause side effects
- Not intended to be used as a daily birth control
Name*

First NameLast Name
Signature*

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