Abortion Fund of Ohio: Client Feedback

This form is for clients who reached out to Abortion Fund of Ohio for financial, logistical, or emotional support, and can be filled out after your experience with us. You're not required to fill out this form. Filling the form out or providing negative or positive feedback doesn't impact current or future ability to get help from AFO. 

We created this form simply because we want to provide the best care possible! Please feel free to be as honest as possible, but don't write any secret or confidential information on this form (like your social security number or home address). 

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First Name & Last Initial -  If you want to be anonymous, please write the month & year you reached out to us. *
Which patient navigator helped you? *
Did the support you received from AFO alleviate barriers to accessing your abortion care?
 *
Here's some space to leave a note or feedback for AFO, the Patient Navigation team, or the Patient Navigator that helped you
If you left a note above, can we share it anonymously on our social media or website? *
Do you want to stay in touch and learn more about AFO events, volunteer opportunities and abortion storytelling?  *
If yes, please leave your email here. If no, please write "NA" *
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