Intact America needs your help.

 

We need to know if your son, grandson or other boy you care for has been the target of forced foreskin retraction at the hands of a medical professional. If so, please tell us about it by filling out this form.

With regard to this report about forced foreskin retraction in a boy I care for, I am the…*
  • Mother
  • Father
  • Grandparent
  • Doctor
  • Nurse
  • Victim/Survivor
  • Other (please explain below)
The person(s) who forcibly retracted the foreskin was:*
  • Doctor
  • Nurse
  • Other Medical Professional
  • Other Adult
The result(s) were:*
  • Pain
  • Bleeding
  • Adhesions
  • Infection
  • Eventual circumcision
  • Formal physician complaint
  • Change of physician
  • Lawsuit
  • Other (please explain below)

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Phone*

In the “Additional Comments,” section below, please give us as much information as you can: 

 

Tell us...

  1. The age of the child who was forcibly retracted. 
  2. The date when the forced retraction occurred. 
  3. The name of the doctor, nurse, or other health care worker who forcibly retracted the boy’s foreskin.
  4. The name and address of the medical practice or hospital. 

After receiving your form, we may contact you by phone or email for more details. We are prepared to follow up with a letter and educational material to the medical provider or facility you name, furnish them with educational information, and tell them that forced foreskin retraction is never ok.

 

We will NOT reveal your name, and we do not need the name of the boy. 

 

Thank you for your help. As this project moves forward, we will keep our followers informed as to next steps. If you have any questions or concerns, you may contact us at: Info@IntactAmerica.org

Additional Comments

Security Code