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    Please note that this is not a booking but a request for an appointment. We will confirm your date and time with you.

    Name *

    E-mail *

    Contact number *

    Nearest Centre? *

    Please choose the Marie Stopes Center nearest to you

    Preferred date of appointment *

    If you would like to visit a Marie Stopes centre within the next 24 hours please call our call centre on 0800 11 77 85.

    Preferred time *

    Comments or questions

    I allow Marie Stopes South Africa to contact me regarding my booking. *