Reschedule / Change An Appointment - Falls Church Healthcare Center

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ABORTION PILLS
PROCEDURAL ABORTION
- Awake (through 12 weeks)
- Asleep (through 15 weeks)
SERVICES
FEES
- Fees and Insurance
- Financial Assistance
ABOUT
FAQs
PATIENT CENTER
CONTACT US
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ABORTION PILLS
PROCEDURAL ABORTION
- Awake (through 12 weeks)
- Asleep (through 15 weeks)
SERVICES
FEES
- Fees and Insurance
- Financial Assistance
ABOUT
FAQs
PATIENT CENTER
CONTACT US
Español

© 2019

Reschedule An Appointment

This form is for patients who already have an appointment confirmed by phone or email with our staff. If you still need to make an appointment, please use our form to Request an Appointment.

Rescheduling your appointment:

Fill in the basic requested information below.
Select the Gynecological Care or Abortion Care appointment you already have in place.
Let us know if you’d like to reschedule for a different day or for the same day but a different time.
You will be contacted (via your preferred method) to confirm a new appointment time.

Please Note: All appointments rescheduling must be confirmed by a Health Educator. We will usually get back to you within 24 hours. If you have any questions or you need to reach us regarding an appointment scheduled sooner, please call us at 703-532-2500.

After submitting your reschedule request, please remember to complete your patient forms online before your appointment.

Questions? Call 703-532-2500 for help your appointment or form completion.

Reschedule An Appointment

Today's Date
MM slash DD slash YYYY
Patient's Full Name*
First Last
Patient's Birthdate*
Month
Day
Year
Preferred Method of Contact*
- Phone
- Email
Patient's Mobile Phone Number*
Patient's Email Address*
Are you comfortable speaking with our staff in English?*
- Yes
- No
Which language(s) would you prefer to speak?
(Members of our staff can speak Spanish, Hindi and Nepali. We may ask you to provide an adult translator on the phone if we cannot accommodate your language.)
Select your appointment type*
- ABORTION CARE (includes options counseling)
- GYNECOLOGY (non-pregnant patient only)
Gynecological Care
Which date is your appointment CURRENTLY scheduled for?*
Month
Day
Year
Do you want to reschedule...*
- to a different day?
- to a different time on the same day?
- I need to cancel my appointment.
Select your preferred day to reschedule your appointment:
Abortion Care
Which appointment are you looking to reschedule?*
- Telehealth
- In-Person
- Both Telehealth and In-Person
Which date is your Telehealth appointment CURRENTLY scheduled for?*
Month
Day
Year
Do you want to reschedule your Telehealth appointment...*
- to a different day?
- to a different time on the same day?
- I need to cancel my Telehealth appointment.
Select your preferred day for your Telehealth appointment:
Which date is your In-Person appointment CURRENTLY scheduled for?*
Month
Day
Year
Do you want to reschedule your In-Person appointment...*
- to a different day?
- to a different time on the same day?
- I need to cancel my in-person appointment.
Type of Abortion Care
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To A Different Day
Select your preferred day to reschedule your In-Person appointment
Select your preferred day to reschedule your In-Person appointment
Select your preferred day to reschedule your In-Person appointment
Approximately how many weeks has it been since your last menstrual period?
You can calculate this by using our Pregnancy Calculator. (Opens in a new window)
Select your preferred day to reschedule your In-Person appointment
Select your preferred day to reschedule your In-Person appointment
Select your preferred day to reschedule your In-Person appointment
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Everyone
Additional Comments
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Section Break
PLEASE READ AND ACKNOWLEDGE THE FOLLOWING:*
- I acknowledge that I am submitting a request to change my scheduled appointment. This is not a confirmation that your original appointment time has been canceled or rescheduled. A member of our staff will contact you to complete and confirm rescheduling.
CAPTCHA

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We have appointments on April 23, 26, & 27 for the asleep procedure. We have medication abortion (pills) appointments on April 25 & 27. Fill out an appointment request now.

Tenemos citas para el procedimiento el 23, 26 & 27 be Abril y el 25 & 27 para las pastillas. Complete una solicitud de cita.