This is a two-fold form. The first part of it is a for a survey that will assist us in understanding the background to your experience. The questions are written as though you are the mother of the child that was killed by abortion. Please fill this in as fully as possible, even if it was not you personally who underwent the abortion procedure. You may be the father, grandparent, or sibling of the unborn child; or you may be no relative at all but it is something that you wish to express your experience about.
The second part is where you can tell 'your story'. The additional information is requested so that we can contact you. It will only be your story that will appear on this website with your first name and town/area. If we get a number of people in your area who indicated that they would like to be put in contact with others in the same area, for support or to form a group, then we will contact each person to confirm this before putting you in contact with each other.
Required form fields are highlighted in red.
May Blossom Contact Form
If you have had more than one abortion experience please tick this box and fill in a separate form for each.
In which year was your abortion experience?
How old were you?
What form of contraception, if any, were you using at the time?
How many weeks pregnant, from your last monthly period, were you?
What was your social status eg student, working, married?
What was your relationship to the unborn child eg mother, father, grandparent, friend?
Who first suggested abortion as a solution to the pregnancy?
Who else supported this abortion decision?
Was there anyone who objected to this decision?
Which organisation did you use to obtain your abortion? NHS Private NHS funded in Private Clinic Other - Please specify
If there was a financial cost to you, how much did you have to pay?
Did anyone help you with the financial costs, if so, who?
Where was the abortion procedure carried out? Local clinic/hospital In a different town/city
How long were you in the clinic/hospital?
What was the abortion method?
What counselling, if any, did you receive before the abortion experience and from whom?
What counselling, if any, did you receive after the abortion experience and from whom?
How long after the abortion procedure was it that you realised you had made a wrong decision?
Please use the following part of this form to 'tell your story'.
First Name: Last Name: Please select: Female Male
Town: County/State: Country:
Your e-mail address:
If there are others in your area would you be interested in being put in contact with them? Yes No
Thank you for your time and energy in completing this form and speaking out against the killing of children by abortion. We realise that it may be very painful to you by filling in this form, especially if you have never spoken about your experience or feelings before. Our prayer is that this will be part of your healing.
Disclaimer - In submitting this form, I accept full responsibility for any outcome that may occur following submission of this information. I acknowledge that NO claim can be made against 'May Blossom', 'United for Life', 'Make Abortion History' or their representatives.
