Get Abortion Pills from Roxy!

1
Are these pills for you or someone else?* This field is required.It is ok to be helping someone get pills, but you CANNOT fill out the other medical form for someone else ---- even if they are your sibling, partner, or child. The person taking the pills needs to be the one who consents to their medical care.
Yes, the pills are for me.
No, the pills are for someone else who isn't going to be involved in the intake process.
2
Where do you need the pills sent?* This field is required.They can be sent to you, or sent to a trusted friend or family member.
CA - California
DE - Delaware
CT - Connecticut
DC - Washington, DC
MA - Massachusetts
ME - Maine
MD - Maryland
MN - Minnesota
NM - New Mexico
NY - New York
OR - Oregon
WA - Washington
IL - Illinois
Other - Somewhere Else
CO - Colorado
3
Are you 16 or older?* This field is required.Right now we are only set up to help people 16 and older in your state..
Yes
No
4
Are you 14 or older?* This field is required.Right now we can only help people 14 and older in your state.
Yes
No
5
Do you have Medicaid insurance?* This field is required.They may call it something different like “Medi-Cal” in your state.
No.
I have applied and I am waiting to hear back.
Yes.
6
You may be able to get FREE abortion pills by mail with Medicaid!* This field is required.While Roxy doesn't take Medicaid, other abortion places in your state do take Medicaid and can mail pills to you at no cost — no clinic visit or travel needed. This can help Roxy to use more of our discounts for people who do not have any insurance at all. *Would you like Roxy to help you find a place to get pills by mail for free with Medicaid?*
Yes, please show me where/how to get free pills with Medicaid!
No, thank you.
7
Even if you're waiting for approval, you may still be able to get free abortion pills by mail with Medicaid!* This field is required.This is called Presumptive Medicaid. While Roxy doesn't take this payment method, other abortion places in your state do take Medicaid and can mail pills to you at no cost — no clinic visit or travel needed. This can help Roxy to use more of our discounts for people who do not have any insurance at all. **MANY PLACES CAN EVEN USE YOUR MEDICAID IF YOU ARE STILL WAITING FOR YOUR MEDICAID TO BE APPROVED** *Would you like Roxy to help you find a place to get pills by mail for free with your Presumptive Medicaid?*
Yes, show me where/how to get free pills using Medicaid!
No, thank you.
8
When was the first day of your last normal period (how far along are you)?* This field is required.Normal period just means what's normal for you! Medically we count your pregnancy from the first day of your last period.
I am not pregnant, I need the pills for the future.
I'm pregnant, and my last period was less than a month ago (4-5 weeks pregnant or less)
I'm pregnant and my last period was 1 - 3 months ago (between 5-13 weeks pregnant)
I'm pregnant, and my last period was more than 3 months ago (more than 13 weeks pregnant)
9
Your last period was a long time ago, so we might need more information.* This field is required.Your provider might need to see medical records or ask you to get an ultrasound.
I have records from a doctor that I can send through the website when you request them, and I'll find them and get them ready now.
I don't have any records right now that show how far along I am, but I can work with the provider to find a low-cost ultrasound or other test if it's needed. (Roxy works hard to maintain a list of places and resources that have this care).
I have not seen a doctor or had an ultrasound, and I would not be able to get one even if I need to.
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