Make an appointment

AbortionWhat was the first day of your last period? *

Date of referral from the doctor

When did you have an echo?

Consultation preferencesWhich date(s) do you prefer?

First choice*:

Second choice:

Third choice:

(Note: Please keep in mind that after the referral from the doctor, there will be an additional period of 5 days in which you need to consider your decision, for an abortion of a pregnancy exceeding the term of 6 weeks.)

In which clinic do you want to make the appointment

First choice*:

Second choice:

(Note: Appointments for abortion of pregnancies between 13 and 17 weeks can only be made in our clinics in Maastricht and Leiden and for pregnancies between 17 and 22 weeks only in our clinic in Leiden.)

Note

Your personalia

First and lastname: *

Street and number: *

Postalcode: *

City: *

Country: *

Phone number: *

E-mail address: *

Date of birth*:

* All items marked with an asterisk (*) are mandatory