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Request a Consultation

ONLY COMPLETE THIS FORM IF YOU LIVE IN ONE OF THE TRUST AREAS LISTED BELOW AND ARE LESS THAN 10 WEEKS PREGNANT. If you are more than 10 weeks pregnant please see information here.  

If you are less than 10 (no more than 9 weeks and 6 days from the first day of your last period) weeks pregnant and want to access early medical abortion in Northern Ireland, BPAS are taking bookings for clients on behalf of the following Trusts:

  • Northern Trust
  • Belfast Trust
  • South Eastern Trust
  • Southern Trust
  • Western Trust – depending on your postcode you will be referred for consultation to either Northern Trust or Southern Trust.

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


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

Medical Questions

Your Address Details

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.