Patient Information Leaflet Order Form

Below is the full list of available leaflets. Type in the boxes next to the leaflet name, the number of copies of each you require. If you do not want any of the named leaflet, leave the box blank.

Question Title

* 1. Your details

Full name

Title

Organisation

Email address

Telephone number

Head of Department Name

Head of Department Email

Question Title

* 2. Full delivery address including ward number, clinic or department name (please be as clear as possible to avoid deliveries being refused and additional costs being incurred by the M.A.).

Address line 1

Address line 2

Address line 3

City or town

County

Postcode

Question Title

* 3. Please send me the following leaflets:

1. Contact cards (max 250)

2. Your miscarriage (max 200)

3. Management of miscarriage (max 200)

4. Recurrent miscarriage (max 200)

5. Ectopic Pregnancy (max 200)

6. Molar Pregnancy (max 200)

7. Late Miscarriage (max 200)

8. Partners too (max 200)

9. Pregnancy after loss (max 200)

10. Looking after your mental health (max 200)

11. Your feelings after miscarriage (max 200)

12. Why me? (max 200)

13. Thinking about another pregnancy (max 200)

14. Pregnancy loss and infertility (max 200)

15. Antiphospholipid syndrome (max 200)

16. Miscarriage (the facts and your feelings) - a booklet for young people (max 200)

17. When the trying stops (max 200)

18. Supporting someone you know (max 200)

19. Miscarriage Information illustrated booklet (an easy-read publication especially suitable for people with learning disabilities or language barriers. Max 20)

20. Miscarriage and the Workplace (max 200)

22. Miscarriage Association poster