Request an Appointment

Please complete this form and a staff person will contact you as soon as possible. If you have not heard from us within 24 hours, please call 1-800-447-7354. Please note, if you are sending this request on the weekend, we may not return the call until Monday.


The information being asked here is no different than what you would be asked over the telephone. Though we make every effort to keep your information secure, it is still possible that the information you provide could be captured by individuals who are engaged in illegal cellular observance. By providing and submitting your confidential information, you accept the risk of sending this information by email to Northland Family Planning Centers personnel.