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

First name(verplicht)

You don't have to enter your official name.

Suffix

Surname(verplicht)

You may choose which name you want to be contacted with.

Indicate which day you want to be called.(verplicht)

Monday Tuesday Wednesday Thursday Friday

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).

E-mail

Telephone number(verplicht)

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.

Toon extra informatie over de verwerking van uw persoonsgegevens

Why is this data required?

We will use your data, with your permission, to schedule a call appointment. Without this data, we are unable to contact you.

How does your data get processed?

We will use your details to contact you by phone. This will be done by our own staff. Your details will not be shared with third parties.

How long do we keep your data?

Once we have contacted you by phone, we will remove your details from our system.

What are your rights?

Meer informatie over uw rechten vindt u op de pagina 'Privacy' (link opent in nieuw tabblad).

Statement of agreement(verplicht)

I have read and understood how my personal data will be processed.