Anonymously Report Abortion Impact

Abortion pills can impact not only the patient, but also family members and friends. You deserve a safe space for your story to be heard.

The purpose of collecting this information is to understand adverse effects of abortion pills received outside of a clinical setting. It helps by revealing patterns and percentages of people who may have had an unfavorable event during an abortion process. These results and anonymous testimonies may be used to inform and educate to prevent future adverse abortion experiences.

Any information that could be identifying will not be shared publicly. You may choose to refrain from any questions you are uncomfortable answering. The form can be submitted with questions left unanswered.

Anonymous Report

What is your relation to the person who took the abortion pill?

Do you know the type of pills received?
Where did the patient hear about the abortion pill provider?
Was the patient pressured into abortion or given an abortion without consent?
Did anything else come in the same package as the pills?

Optional: For Follow Up Contact Only

You may choose to provide this information if you would like us to follow up for additional information or to provide support. Any identifiable information provided will not be shared publicly.
I would like to provide this information for you to: