Section 1 of 17
Have You Contacted or Visited a Crisis Pregnancy Center in Massachusetts?
The Abortion Truth Campaign is documenting how CPCs treat pregnant people in Massachusetts.
YOUR STORY MATTERS - PLEASE SHARE IT WITH US! Your story will help expose how CPCs operate, and help prevent other women+ seeking healthcare from being misled and harmed by these fake clinics.
CPCs often call themselves "pregnancy resource centers" or "women's health clinics." You can check here to confirm whether a place you contacted was a Massachusetts crisis pregnancy center.
If you have had contact with a MA CPC, did you think it was an abortion provider or medical clinic? What happened when you contacted and/or visited the center? Did anything happen that made you uncomfortable?
If you are willing to share your story, please complete this form.
You will remain anonymous, unless you indicate that you are willing for us to use your name.
Don't hesitate to contact us if you have any questions. Thank you!
Section 2 of 17
What MA CPC did you have contact with?
Q1. What crisis pregnancy center did you contact and/or visit?
For a list of Massachusetts CPCs, see: abortiontruthcampaign.org/where-are-they)
Q1. What crisis pregnancy center did you contact and/or visit?
For a list of Massachusetts CPCs, see: abortiontruthcampaign.org/where-are-they)
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How did you interact with the CPC?
How did you interact with the CPC?
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Online chat
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Telephone call
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In-person visit
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Section 3 of 17
Online contact?
What website did you use to connect with the CPC?
What website did you use to connect with the CPC?
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Section 4 of 17
Telephone call?
What number did you call to speak with the CPC?
What number did you call to speak with the CPC?
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Section 5 of 17
In-person visit?
What is the address of the CPC you visited?
What is the address of the CPC you visited?
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Section 6 of 17
How did find out about the CPC?
How did you find out about the crisis pregnancy center you contacted or visited?
How did you find out about the crisis pregnancy center you contacted or visited?
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Internet search
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Friend
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Someone approached me
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Billboard advertisement
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Section 7 of 17
Question 2a
Please let us know how you found the center.
Please let us know how you found the center.
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Section 8 of 17
Question 3
Q3. Did you think you were talking to/visiting a medical provider?
Q3. Did you think you were talking to/visiting a medical provider?
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Yes
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No
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Section 9 of 17
Question 3a
What made you think the CPC provided medical care? (Multiple choice)
What made you think the CPC provided medical care? (Multiple choice)
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Asked you to complete a medical history form
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Staff identified themselves a doctor, nurse, or other medical professional
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Staff was wearning medical scrubs
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Staff gave me medical advice
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Other:
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Section 10 of 17
Question 3b
What made you think the CPC provided medical care? (Description)
What made you think the CPC provided medical care? (Description)
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Section 11 of 17
Question 4
What services were you seeking?
What services were you seeking?
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Abortion care
Free pregnancy test
Free ultrasound
Free STI test
Pregnancy options counseling
Free material support (diapers, formula, etc.)
Other
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If you answered other in the previous question, what services were you seeking?
If you answered other in the previous question, what services were you seeking?
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Section 12 of 17
Question 5
Please provide any information you are willing to share about your CPC experience. Describe what happened and how your experience affected you.
Please provide any information you are willing to share about your CPC experience. Describe what happened and how your experience affected you.
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Section 13 of 17
Question 6
Are you willing to allow ATC to share your anonymous story publicly?
Are you willing to allow ATC to share your anonymous story publicly?
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Yes, I agree to allow ATC to use my story in education and advocacy about CPCs in Massachusetts
No, please do not publicly use my story. I understand it will be shared internally
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Section 14 of 17
Question 7
Are you are
willing to allow ATC to share your story along with your first or full name?
Are you are
willing to allow ATC to share your story along with your first or full name?
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Yes, I am willing to have my name used in stories ATC shared about CPCs in Massachusetts
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No, please do not use my name when sharing my CPC story. If you don't enter a name, we will use "Anon."
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Section 15 of 17
7a
Please enter the name you would like us to use. For
example, Jane; Jane S., Jane Smith, or J.S.
Please enter the name you would like us to use. For
example, Jane; Jane S., Jane Smith, or J.S.
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Section 16 of 17
Question 8
ATC is occasionally asked
to provide commentary for media stories about CPCs and reporters often ask if we can refer them to people who have been to a CPC. If you are open to speaking to reporters about your CPC experience, anonymously or using your initials or name, please provide your
email below and we will contact you. Unless you
agree, ATC will not share your identity and information with reporters.
ATC is occasionally asked
to provide commentary for media stories about CPCs and reporters often ask if we can refer them to people who have been to a CPC. If you are open to speaking to reporters about your CPC experience, anonymously or using your initials or name, please provide your
email below and we will contact you. Unless you
agree, ATC will not share your identity and information with reporters.
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Yes, I am willing to share my story to be used with reporters.
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No, I do not want to share my story with reporters.
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Section 17 of 17
Question 8a
Please provide your name and contact information. ATC will contact you before sharing your story or referring to you a reporter. THANK YOU!!
Please provide your name and contact information. ATC will contact you before sharing your story or referring to you a reporter. THANK YOU!!
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