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Get Support

If you are in need of funding support to access abortion care, please complete this form.

Intake Form - English
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Client Contact Information

If different from the name provided above.
Learn more about pronouns and why we ask for your pronouns here. Ex. she/her, he/him, they/them

Cobalt Abortion Fund strives to keep your information safe and secure.

Cobalt Abortion Fund requires certain contact and appointment details to start our funding process. A member of our team will call, text, or email you based on your answers above to start the funding process. We take your answers to our contact safety questions seriously.

A note about email.

The Cobalt Abortion Fund intake team will send emails with status updates from a no-reply email address to the email provided. If you are unable to receive emails due to a safety concern, please do not submit this intake form and reach out to the clinic you are scheduled at for further assistance.

Hours of Operation + Response Time

Monday – Friday, 9am to 5pm.
We are usually open Monday through Friday, 9am to 5pm Mountain Time. We close for most federal holidays, and occasionally additional breaks, and will close our intake form and let current clients know about our closures.

Response times happen within our working hours.
We typically respond within 48 business hours of when you submit your application. We appreciate your patience. Your right to access abortion care is our priority.