Connect to a Rouge Doula

Connect to a Rouge Doula

We offer support before, during, and after a medication (pill-based) abortion. This form is secure and private—your information will not be shared outside of Rouge Pills. Please note: Rouge Pills is not a substitute for medical care or legal advice. We do not sell abortion pills but can connect you with verified and trusted pill providers. We’re not able to provide funding at this time, but we can connect you with other resources that may be able to help. After submitting this form, you can expect to hear from us within 24 hours with the subject line 'Your request for Rouge Doula care.'
Name (feel free to use whatever name makes you most comfortable):*
How would you like us to contact you? Click all that apply.*

EmailSignal app (You can download Signal here: https://signal.org/download/)Whatsapp
Email (if you don't have an email, write 'none')*
example@example.com
Phone number (ONLY if you prefer to communicate by Signal or Whatsapp)

Country Code (USA is +1)Area CodePhone Number
Rouge Doulas speak many languages. What is your first preferred language to talk to us in?*
What is your second preferred language? Write 'none' if this doesn't apply to you.*
What is your location? Please be as specific as is comfortable for you.* This allows us to better match you with the right resources.*
*City, Town, Region, Country, etc.
Estimate your first day of last period (when was your last menstrual bleed?) *

MonthDayYear
Date
Have you confirmed your pregnancy?*

Yes, through an ultrasoundYes, through a urine pregnancy testYes, through a blood testNo, but I'm having pregnancy symptoms and/or missed periodI'm unsure if I'm really pregnant
How many weeks pregnant are you? (If you don't know, write 'unsure')*
Do you have access to insurance coverage or universal health care in your country of residency? We can help you access care worldwide regardless of insurance status.*
If needed, please provide us with more details about your answer in the above question about insurance. This improves our ability to find helpful resources for you.
Examples: I have insurance but my deductible is too high, I don't have access to healthcare that accepts my insurance, I don't qualify for universal health care, etc.
What concerns do you have today?*

I'm not sure whether or not to have an abortion.I need help accessing abortion.I am currently having an abortion and need support.I need emotional or other support.I need information about how to take abortion pills.
Rouge Doulas provide emotional & practical support to use abortion pills. Do you have any other specific needs or desires you would like to share with us?
Examples include: religious or spiritual concerns, gender identity, herbal support, sexuality, post-abortion support, etc.
How did you hear about us?

Instagram, Facebook, social mediaReferred by a friend or someone you knowGoogle, Search EngineI've received Rouge services beforeRouge website or blog
PLEASE NOTE: Our doulas will get in touch with you from a variety of email addresses and numbers. To be sure it is from us, look for a subject line that says 'Your request for Rouge Doula care'. Please check your spam folder if you don't hear from us within 24 hours.
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