Request call-back

By filling in this form, you are requesting a staff member from the Unplanned Pregnancy Information Centre to call you. Dutch or English will be spoken during the call.  

Call request Unintended Pregnancy Information Centre

You don't have to enter your official name.
You may choose which name you want to be contacted with.
Indicate which day you want to be called.(verplicht)
Due to the time difference between the Caribbean and Europe, we will call you in the morning. We will do this on the next weekday chosen by you. Please note, we will call anonymous (without caller id).
Information about the processing of your personal data

We will use your data to schedule the call appointment and call you. Afterwards, they are removed. Your data will not be shared with third parties.

Statement of agreement(verplicht)