Forms

In order to better serve you, we offer most of our information sheets and patient forms online. We do not require that you complete these forms prior to your appointment, however please feel free to do so. If you are still unsure of which abortion method suits your individual needs, please talk to one of our staff, or complete this online workbook: Abortion—Which Method is Right for Me?

Forms required for all abortion procedures:

Medical History

Medical-History – English Medical-History – Spanish

Counseling Conversation Worksheet

Counseling Worksheet – English Counseling Worksheet – Spanish

Birth Control History and Consent

Contraceptive Screening – English Contraceptive Screening – Spanish

Sonogram Consent Forms

Sonogram Consent Form – English

Additional forms for the abortion pill:

Abortion Pill Information Packet

Medical Abortion Info – English Medication Abortion Info – Spanish

Medical Abortion Consent

Medication Abortion Consent – English Medical Abortion Take Home – English

At Home Symptom Diary

At Home Symptom Diary (English)

Additional forms for early surgical abortion:

First Trimester Surgical Abortion Information Packet

1st Tri Surgical Info Packet (English) 1st Tri Surgical Info Packet (Spanish)

Surgical Abortion Consent

Surgical Abortion Consent (English) Surgical Abortion Consent (Spanish)

Surgical Abortion Post-Op Instructions

Surgical Abortion Post Op (English) Surgical Abortion Post Op (Spanish)

Additional forms for second trimester abortion:

Second Trimester Surgical Abortion Information Packet

2nd Trimester Info (English) 2nd Tri Information Packet (Spanish)

Surgical Abortion Post-Op Instructions

Surgical Abortion Post Op (English) Surgical Abortion Post Op (Spanish)

Patient rights and responsibilities form:

(Required for patients seeking second trimester abortion care) Patient rights and responsibilities (English)

Hand Hygiene Policy

Baltimore Infection Control Policy Credentialing Policy