Abortion Questionnaire

How old are you? (Under the EU-data protection act regrettably we are not allowed to advise women under the age of 16 without the express permission of the parents.) *

What country are you from? *

How long have you known that you are pregnant? *

The pregnancy (you can tick several boxes)

It has been a total surprise for me.

I already had a sense that I was pregnant.

I took a pregnancy test which came up positive.

The pregnancy has been confirmed by the GP/Gynaecologist.

The pregnancy was initially planned.

What week of the pregnancy are you in? (if the pregnancy has been confirmed by a medical doctor)

When I found out I was pregnant I…

If you selected "In your own words" please fill in below

Who have you spoken to about your pregnancy?

If you selected "Others" please fill in below

Since becoming pregnant, I have a sense of: (you can tick several boxes)

Uncertainty, but I hope to make a good decision.

Indecision.There are many reasons for and against a baby.

Confusion.I feel under pressure.

I do not recognise myself because of the immense pressure on me;I am completely beside myself.

In your own words:

If you selected "In your own words" please fill in below

Which image best represents your present situation.

In my life to date I have been able to manage difficult situations by… (you can tick several boxes)

Using my common sense on how best to deal with challenges.

Making a gut feeling decision. I am able to trust my gut feeling in most cases.

Talking to others. If I speak with others whom I trust, I feel more able to make good decisions.

Keeping my own counsel. Too many opinions and too much advice make me insecure.

How does your everyday life fare, since you came to know of the pregnancy?

Have you informed yourself about pregnancy and abortion? (you can tick several boxes)

Yes, I have already been to a pregnancy support centre.

Yes, I already have a date for an abortion.

Yes, I read a lot on the internet.

Yes, I have spoken a lot with friends and acquaintances about this.

No not yet.

What do you think would be most helpful to you in this current situation?

Which values are most important to you? (you can tick several boxes)

If you selected "Other" please fill in below

Please describe your personal situation in a few sentences:

Your First name: (Giving your name will help us to address you as an individual when responding to your situation.)

Email

In addition to the written response from the advisory team, I also wish to avail of telephone consultation/counselling.

We protect your personal data. By completing the test you agree that Ask Majella Pregnancy Support Service uses and stores your data for the purpose of the advice and the advise-documentation. Your personal data will not be passed on to third parties, but shall be stored for a limited time only. For further information on how we protect your data see our Privacy Policy - https://askmajella.com/privacy-policy/

I Agree

Abortion Questionnaire

Abortion – yes or no?

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Abortion Questionnaire

Abortion – yes or no?

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