Appointment Form

Please fill out the form below prior to your appointment.

Female Client Intake Form

To protect the privacy of our guests, please turn off your cell phones and other personal electronic devices during your appointments.

If you would like, please read our Privacy Responsibilities under HIPAA.

Step 1 of 4

  • Application Form 2020

  • Date Format: MM slash DD slash YYYY
  • Consent Form & Disclaimer

  • Date Format: MM slash DD slash YYYY

All services at Pregnancy Help Center are provided at no cost to you.

Location & Hours

4845 Market St., Suite 13, second floor
Youngstown, OH 44512

Reduced hours due to COVID-19:
Tuesday: 10am – 4pm
Wednesday: 10am – 4pm
Thursday: 10am – 4pm

Call to Schedule an appointment

Center phone: 330-788-4000

Please bring a photo ID with you to your appointment.