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 Doulas. Please note: Rouge Doulas 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.
Name (feel free to use whatever name makes you most comfortable):
How would you like us to contact you? Click all that apply.
Email (if you don't have an email, write 'none')
example@example.com
Phone number (so that we can 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?
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?
Rouge Doulas provide logistical, emotional & practical support to use abortion pills. Do you have any other specific needs, desires or concerns you would like to share with us?
Examples include: religious or spiritual concerns, gender identity, herbal support, sexuality, post-abortion support, etc.
PLEASE NOTE: Our doulas will get in touch with you within 24 hours and from a variety of numbers. To be sure it is from us, look for an introduction that says 'Your request for Rouge Doula care'.
How did you hear about us?
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