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Information Brochure English: (click here to download PDF)
Informacion en Español:(clic aquí para download PDF)
Unemancipated Minor Parental Consent Notarization English:(click here to download PDF)
Certification of Emancipated Minor Status in English: (click here to download PDF)
Certificación de estado emancipado del menor de edad en Español: (clic aquí para download PDF)
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Pre-Information Forms The Virginia State Legislature requires
that five points of information be shared with each patient who makes an
appointment for a pregnancy termination.
The following PDF files provide that information which can be reviewed
with one of our Counselors. More
detailed information regarding the procedure will be discussed during your
registration and on day of your appointment.
In order to save time on the day of your appointment, you may request
to complete the necessary lab work and paperwork in advance by
Pre-Registering. You can also print out and complete the Medical History form
from the Patient Instructions Page of
our website to bring with you on the day of your appointment. After reading the following
pre-information, print out the Certification
of Pre-Information form and bring it with you to your scheduled appointment. A Healthcare Educator, Counselor, or Nurse
is happy to answer your questions by phone, in person, or by e-mail at gyn@fallschurchhealthcare.com. Please follow one of the following links to receive the pre-information about the procedure you are interested in: |
Certification of Pre-Information
PLEASE PRINT OUT THIS FORM AND BRING IT WITH
YOU TO YOUR SCHEDULED APPOINTMENT.
Certification of Pre-Information in English: (click here to download PDF)