Take Back Trust: Provider Visit Planner
This tool is to help you make the most of your upcoming appointments with your healthcare provider. Select any applicable questions to create a personalized list. After completion a personalized PDF will be created that can be emailed to you and downloaded. Feel free to screenshot or print it and take it to your appointment.
Legal & Privacy Concerns
What privacy measures does your office take to protect my reproductive health data, especially with digital health records?
How do you handle referrals if I need out-of-state abortion care or other reproductive health services?
What steps are you taking to protect patient confidentiality if new laws affect reproductive health care or access to services?
What rights does my partner have when it comes to my medical care? How are the decisions that I make kept private?
If you'd like to receive your list via email, please provide your email here. This is optional - you do not need to submit your email if this feels uncomfortable to you.
This email address is only used to send your list, and will not be shared externally.
Get My List
Should be Empty: