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Before you book your Tele-Abortion, we recommend that you first complete the Suitability Checklist below.

Note: the form may take a few moments to load,

Tele-Abortion Suitability Checklist

Please be 100% honest with your answers. If you're not honest, you could be putting your health (and life) in danger!

Are you more than 9 weeks (63 days) pregnant?
Are you under 16 years old?
Do you speak English fluently?
Do you live within 2 hours of a hospital facility?
Do you take any steroid medication regularly (eg. for arthritis or asthma)?
Are you on blood thinning medication (anticoagulants) of any kind?
Do you have an IUD in your body?
Do you have a known allergy to Mifepristone, Misoprostol or prostaglandins?
Do you have a known or suspected ectopic pregnancy?
Do you have a known or suspected bleeding disorder?
Do you have a known or suspected infection in the womb or fallopian tubes?
Do you have known or suspected issues with your adrenal glands?
Are you anaemic?
Are you willing to undergo a surgical procedure if it is considered necessary? In around 1-2% of cases, the medical abortion does not complete properly. We will follow you up to ensure you are looked after properly if this is the case.

Important Notice - Please Read!


If you had to change any of the default answers above, you may not be suitable for medical termination of pregnancy by tele-health. However, you can still book an initial consultation to review your situation. If you choose to make an appointment, a copy of your suitability checklist will be sent to your Consultant.

Please note that passing this suitability checklist does not necessarily mean that you will be suitable, and further ultrasound testing is required. An ultrasound request will be given to you during your first consultation, and you will need to have this done locally before we can prescribe the medications. 

©  2020 Clinic 66  |   Your privacy is 100% our policy

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