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Home › Consent to medical termination of pregnancy

Home › Consent to medical termination of pregnancy

​Consent to medical termination of pregnancy

Name(Required)
Date of Birth(Required)
Email address(Required)


  • Before proceeding with medical termination of pregnancy using please read the following information carefully and click each checkbox to indicate you have understood and agree with the information provided to you.
  • Any specific concerns should be discussed with your doctor prior to submitting the consent form.
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By clicking submit I confirm that I have read and understood the information above. The treatment has been explained to me in language I understand. I have had the opportunity to ask questions and I am satisfied with the answers given. I consent to medical termination of pregnancy.