Patients Forms
Consent to Abortion
Please use this form if you are having an abortion procedure at AWC. This form will explain the procedure, risks, pre-procedure testing and post-procedure care. You will meet with a counselor or patient advocate to review this consent on the day of you appointment and she will be able to answer any questions you may have about this form at that time.
For a one day procedure, please download this form AWC Consent form
For a two day procedure, please download this form AWC Consent form – overnight
Medical History
Please use this form if you are having an abortion procedure at AWC. This form tells us about your medical history. It is extremely important for our physicians and medical staff to know your entire medical history in order to provide the safest care possible.
HIPAA Acknowledgement
Please use this form if you are having any service at AWC. By signing this form, you acknowledge that you understand the Health Insurance Portability and Accountability Act. If you have any questions regarding HIPAA, you may speak with our staff on the day of your procedure or call (404) 257-0057.
HIPAA Disclosure
This form explains the Health Insurance Portability and Accountability Act. If you have any questions regarding HIPAA, you may speak with our staff on the day of your procedure or call (404) 257-0057.
How to Choose an Abortion Provider
If you have questions about how to find the best abortion provider for your care, this information will help you ask the right questions to get the care you need.
How to Choose a Quality Abortion Provider
Surgical Forms
1st Trimester Surgical Abortion — Please review this information if you will be having a 1st trimester surgical abortion procedure at AWC. It is very important for you to follow these instructions in order to have a safe surgical procedure.
AWC – Appointment Confirmation and Reminders for Patients
2nd Trimester Surgical Abortion (2-Day Procedure) – Please review this information if you will be having a 2nd trimester surgical abortion (2-day procedure) at AWC. It is very important for you to follow these instructions in order to have a safe surgical procedure.
AWC – Appointment Confirmation and Reminders for Patients
AWC Overnight Laminaria instructions
Post-Operative Instructions – This form details all of the instructions you will be asked to follow after a surgical abortion procedure. Our nursing staff will review all of this information with you on the day of your procedure.
Medical Abortion Forms
Medical Abortion Information and Instructions
Please review these instructions if you will be having a medical abortion procedure (non-surgical abortion) at AWC. The medical abortion is an option for women who are between 5 – 8 weeks pregnant. It is very important for you to follow these instructions in order to have a safe procedure.
Using Mifeprex AWC Using Mifeprex – Med Guide Alt Tx Plan
Medical Abortion Consent & Treatment Plan
This form will explain the medical abortion procedure in detail– what medications are used, the FDA regimen, what medical conditions are not indicated for MAB use and other important information. If you have questions any questions regarding the medical abortion, you may speak with our staff on the day of your procedure or call (404) 257-0057.
Medical Abortion Discharge Instructions
This document provides information about what to do following the start of your medical abortion procedure and information about what to expect throughout the process. If you have questions any questions regarding the medical abortion, you may speak with our staff on the day of your procedure or call (404) 257-0057.
AWC MAB Discharge Instructions
Parental Notification
Please use this form if you are under 18 years of age. Your parent or legal guardian must sign this form and bring proof of ID to your appointment. If you have questions about the Georgia laws related to parental notification, please click here (link to parental notification page).
AWC Parental notification consent