In order to reduce the amount of time spent at your appointment, please print and fill out the Patient Forms below. Bring them with you to your scheduled appointment.
To the view the following Patient Forms (PDFs) you will need ADOBE Acrobat Reader® installed. For a FREE download click here.
Femi-care Surgery Center Patient Forms
- Patient’s Medical History [PDF]
- Emotional Evaluation [PDF]
- Surgical Abortion Consent [PDFsurgery consent form]
- Patient & Insurance Info [PDF]
- Patient Responsibility [PDF]
- Acknowledgment of Other Options [PDF]
- Receipt of Notice of Privacy Practices [PDF]
- Advance Directive [PDF]
- Physician Ownership Disclosure [PDF]
- Refund Prices [PDF]
- Other Options for TA [PDF]
- Medical Records Release [PDF]