Sign the Statement

This form is for doctors registered in Ireland. Please read the full Statement before signing.

After submitting, you will receive an email asking you to confirm your signature. Your name is not added to the Statement until you click the link in that email.

Statement

Title

First Name

Surname

Email address

Medical Council Registration Number

Used only to verify the integrity of the Statement. It will not be published or shared.

Specialty

Please specify your specialty

Statement agreement

I have read and agree with the Statement in Support of Retaining the Three-day Wait before Abortion.

Privacy agreement

I understand and accept the Privacy Statement.

Optional details

The following are optional and help us describe the signatories in summary.

Retired

I am retired

Have you been involved in providing abortions?

Yes

Not relevant to my role

Display name

I wish to have my name added to the list of signatories displayed on this website.

Comment

Comments may be compiled and provided to Oireachtas members without names attached. Please do not include your name, your hospital or practice, or other identifying details.