Birth Control Denial Complaint Form

If you have gone to the doctor and been denied birth control or have been required to make multiple trips to health care providers just to get basic contraceptive services, we want to hear about your experience. Please fill out the form below to share your story with the ACLU of Illinois.

We treat information provided to us as confidential. We will not publicize your story without your permission.

PLEASE NOTE:

The ACLU of Illinois provides legal representation on certain matters, but solely where the incident occurred in the state of Illinois, or cases involving residents of Illinois. The organization is not a provider of general legal services; it only litigates cases where there has been a violation of a person’s civil rights, primarily by the government. We do not practice criminal law or generally take cases where rights have been violated by a private entity. After receiving your request, it may take up to two weeks to receive a response from the Intake Department. As such, if your case is extremely time-sensitive, you may wish to consult a private attorney. The ACLU of Illinois cannot provide legal advice unless the organization has accepted your case. The receipt of and/or response to your inquiry does not indicate the acceptance of your case.

Please tell us by filling out the form below. Be sure to read about our Intake Procedures before filling out this form. We receive many requests for help, so please bear with us as we try to get to your request. We'll let you know whether we can give you legal assistance. If we can't, we'll try to find another organization that may be better equipped to help.

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Do you live in Illinois? *

Did the incident take place in Illinois? *

If you indicated that you do not live in Illinois, or if the incident in question did not take place in Illinois, the ACLU of Illinois will not be able to assist you. To find the ACLU affiliate in your state, click here.

First Name *

Last Name *

Pronouns

Street Address

City *

State *

Zip *

Phone

Location of incident: *

Date of incident: *

What is the best way to contact you?

Mail

Phone

Please submit a brief summary, of no more than one page, of your experience. If we need more information, we will contact you.

How did you hear about us?

The ACLU selects only a few cases among the many requests for legal assistance that we receive. Our accepting this information from you does not mean we have agreed to serve as your lawyers or to give you legal advice. The information on this form will be kept confidential.

The ACLU of Illinois solely takes cases where the incident occurred in the state of Illinois, or cases involving residents of Illinois. The organization is not a provider of general legal services; it only litigates cases where there has been a violation of a person’s civil rights, primarily by the government. We do not practice criminal law or generally take cases where rights have been violated by a private entity. After receiving your request, it may take up to two weeks to receive a response from the Intake Department. As such, if your case is extremely time-sensitive, you may wish to consult a private attorney. The ACLU of Illinois cannot provide legal advice unless the organization has accepted your case. The receipt of and/or response to your inquiry does not indicate the acceptance of your case.

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