Request a Consultation in Northern Ireland

ONLY COMPLETE THIS FORM IF YOU LIVE IN NORTHERN IRELAND.

If you are more than 18 weeks pregnant please call 03457 30 40 30 to access abortion services in England.

If you are less than 18 weeks pregnant (no more than 17 weeks and 6 days from the first day of your last period) and want to access abortion services in Northern Ireland, BPAS are taking bookings for clients on behalf of the following Health and Social Care Trusts:

Northern Trust
Belfast Trust
South Eastern Trust
Southern Trust
Western Trust.

You will receive a call for consultation within 5 working days or earlier.

All clients will be referred to their local Health Trust in the first instance for triaging and consultation.

You must complete all fields in the form below

Please do not complete this form unless you have a positive pregnancy test.

Personal Details

First name

Surname

Date of birth

Day

Month

Year

Ethnicity

Email address

Phone number

Is it OK to leave a voicemail and send texts to this number?

Yes

Do you need an interpreter / translator for your appointment?

Yes

State which language

Memorable password

Medical Questions

Date of the first day of your last period

Day

Month

Year

Your Address Details

Street

Address

Town or City

Postcode

GP Surgery Details

Your details will be used to obtain your health and care number and your basic health records, your GP will not be contacted.

GP Surgery Name

GP Surgery Postcode